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Patel MM, Adrada BE. Hereditary Breast Cancer: BRCA Mutations and Beyond. Radiol Clin North Am 2024; 62:627-642. [PMID: 38777539 DOI: 10.1016/j.rcl.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Hereditary breast cancers are manifested by pathogenic and likely pathogenic genetic mutations. Penetrance expresses the breast cancer risk associated with these genetic mutations. Although BRCA1/2 are the most widely known genetic mutations associated with breast cancer, numerous additional genes demonstrate high and moderate penetrance for breast cancer. This review describes current genetic testing, details the specific high and moderate penetrance genes for breast cancer and reviews the current approach to screening for breast cancer in patients with these genetic mutations.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA.
| | - Beatriz Elena Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA
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2
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Endrikat J, Schmidt G, Haverstock D, Weber O, Trnkova ZJ, Barkhausen J. Sensitivity of Contrast-Enhanced Breast MRI vs X-ray Mammography Based on Cancer Histology, Tumor Grading, Receptor Status, and Molecular Subtype: A Supplemental Analysis of 2 Large Phase III Studies. BREAST CANCER: BASIC AND CLINICAL RESEARCH 2022; 16:11782234221092155. [PMID: 35462754 PMCID: PMC9021463 DOI: 10.1177/11782234221092155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The impact of certain tumor parameters on the sensitivity of imaging tools is unknown. The purpose was to study the impact of breast cancer histology, tumor grading, single receptor status, and molecular subtype on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) vs X-ray mammography (XRM) to detect breast cancer. Materials and Methods: We ran a supplemental analysis of 2 global Phase III studies which recruited patients with histologically proven breast cancers. The sensitivity of CE-BMRI vs XRM to detect cancer lesions with different histologies, tumor grading, single receptor status, and molecular subtype was compared. Six blinded readers for each study evaluated the images. Results were summarized as the “Mean Reader.” For each reader, sensitivity was defined as the proportion of detected lesions vs the total number of lesions identified by the standard of reference. Two-sided 95% confidence intervals were calculated for within-group proportions, and for the difference between CE-BMRI and XRM, using a normal approximation to the binomial distribution. Results: In 778 patients, 1273 cancer lesions were detected. A total of 435 patients had 1 lesion, 254 had 2 lesions, and 77 had 3 or more lesions. The sensitivity of CE-BMRI was significantly higher compared with XRM irrespective of the histology. The largest difference was seen for invasive lobular carcinoma (22.3%) and ductal carcinoma in situ (19%). Across all 3 tumor grades, the sensitivity advantage of CE-BMRI over XRM ranged from 15.7% to 18.5%. Contrast-enhanced breast magnetic resonance imaging showed higher sensitivity compared with XRM irrespective of single receptor expressions (15.3%-19.4%). The sensitivities for both imaging methods were numerically higher for the more aggressive ER– (estrogen receptor), PR– (progesterone receptor), and HER2+ (human epidermal growth factor receptor 2) tumors. Irrespective of molecular subtype, sensitivity of CE-BMRI was 14.8% to 18.9% higher compared with XRM. Conclusions: Contrast-enhanced breast magnetic resonance imaging showed significantly higher sensitivity compared with XRM independent of tumor histology, tumor grading, single receptor status, and molecular subtype. Trial Registration: ClinicalTrials.gov: NCT01067976 and NCT01104584.
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Affiliation(s)
- Jan Endrikat
- Bayer AG, Radiology R&D, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | - Gilda Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | | | - Olaf Weber
- Bayer AG, Radiology R&D, Berlin, Germany
| | | | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
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3
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Meiser B, Kaur R, Morrow A, Peate M, Wong WKT, McPike E, Cops E, Nichols C, Austin R, Fine M, Thrupp L, Ward R, Macrae F, Hiller JE, Trainer AH, Mitchell G. Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice. Hered Cancer Clin Pract 2021; 19:24. [PMID: 33836815 PMCID: PMC8035714 DOI: 10.1186/s13053-021-00180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background This nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients. Methods Clinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate. Results There were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women. Conclusions Guidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-021-00180-3.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - April Morrow
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Michelle Peate
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - W K Tim Wong
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,School of Social Sciences, UNSW Sydney, Sydney, Australia
| | - Emily McPike
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Elisa Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Cassandra Nichols
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - Rachel Austin
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Miriam Fine
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Adelaide, Australia
| | - Letitia Thrupp
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Robyn Ward
- University of Queensland, Brisbane, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Finlay Macrae
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Colorectal Medicine and Genetics, University of Melbourne, Melbourne, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Hawthorn, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Chiarelli AM, Blackmore KM, Muradali D, Done SJ, Majpruz V, Weerasinghe A, Mirea L, Eisen A, Rabeneck L, Warner E. Performance Measures of Magnetic Resonance Imaging Plus Mammography in the High Risk Ontario Breast Screening Program. J Natl Cancer Inst 2020; 112:136-144. [PMID: 31233143 DOI: 10.1093/jnci/djz079] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/11/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Ontario Breast Screening Program expanded in July 2011 to screen high-risk women age 30-69 years with annual magnetic resonance imaging (MRI) and digital mammography. This study examined the benefits of screening with mammography and MRI by age and risk criteria. METHODS This prospective cohort study included 8782 women age 30-69 years referred to the High Risk Ontario Breast Screening Program from July 2011 to June 2015, with final results to December 2016. Cancer detection rates, sensitivity, and specificity of MRI and mammography combined were compared with each modality individually within risk groups stratified by age using generalized estimating equation models. Prognostic features of screen-detected breast cancers were compared by modality using Fisher exact test. All P values are two-sided. RESULTS Among 20 053 screening episodes, there were 280 screen-detected breast cancers (cancer detection rate = 14.0 per 1000, 95% confidence interval [CI] = 12.4 to 15.7). The sensitivity of mammography was statistically significantly lower than that of MRI plus mammography (40.8%, 95% CI = 29.3% to 53.5% vs 96.0%, 95% CI = 92.2% to 98.0%, P < .001). In mutation carriers age 30-39 years, sensitivity of the combination was comparable with MRI alone (100.0% vs 96.8%, 95% CI = 79.2% to 100.0%, P = .99) but with statistically significantly decreased specificity (78.0%, 95% CI = 74.7% to 80.9% vs 86.2%, 95% CI = 83.5% to 88.5%, P < .001). In women age 50-69 years, combining MRI and mammography statistically significantly increased sensitivity compared with MRI alone (96.3%, 95% CI = 90.6% to 98.6% vs 90.9%, 95% CI = 83.6% to 95.1%, P = .02), with a small but statistically significant decrease in specificity (84.2%, 95% CI = 83.1% to 85.2% vs 90.0%, 95% CI = 89.2% to 90.9%, P < .001). CONCLUSIONS Screening high risk women age 30-39 years with annual MRI only may be sufficient for cancer detection and should be evaluated further, particularly for mutation carriers. Among women age 50-69 years, detection is most effective when mammography is included with annual MRI.
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Affiliation(s)
- Anna M Chiarelli
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Derek Muradali
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Done
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Vicky Majpruz
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Ashini Weerasinghe
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lucia Mirea
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Phoenix Children's Hospital, Phoenix, AZ
| | - Andrea Eisen
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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High-risk breast cancer surveillance with MRI: 10-year experience from the German consortium for hereditary breast and ovarian cancer. Breast Cancer Res Treat 2019; 175:217-228. [DOI: 10.1007/s10549-019-05152-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 01/21/2023]
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6
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Mann RM, Kuhl CK, Moy L. Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging 2019; 50:377-390. [PMID: 30659696 PMCID: PMC6767440 DOI: 10.1002/jmri.26654] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/15/2022] Open
Abstract
Multiple studies in the first decade of the 21st century have established contrast-enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow-up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage-shift increasing the survival benefit of screening. Cost-effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377-390.
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Affiliation(s)
- Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Radiology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Linda Moy
- Center for Advanced Imaging Innovation and Research / Department of Radiology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA
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van Zelst JCM, Mus RDM, Woldringh G, Rutten MJCM, Bult P, Vreemann S, de Jong M, Karssemeijer N, Hoogerbrugge N, Mann RM. Surveillance of Women with the BRCA1 or BRCA2 Mutation by Using Biannual Automated Breast US, MR Imaging, and Mammography. Radiology 2017; 285:376-388. [PMID: 28609204 DOI: 10.1148/radiol.2017161218] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate a multimodal surveillance regimen including yearly full-field digital (FFD) mammography, dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging, and biannual automated breast (AB) ultrasonography (US) in women with BRCA1 and BRCA2 mutations. Materials and Methods This prospective multicenter trial enrolled 296 carriers of the BRCA mutation (153 BRCA1 and 128 BRCA2 carriers, and 15 women with first-degree untested relatives) between September 2010 and November 2012, with follow-up until November 2015. Participants underwent 2 years of intensified surveillance including biannual AB US, and routine yearly DCE MR imaging and FFD mammography. The surveillance performance for each modality and possible combinations were determined. Results Breast cancer was screening-detected in 16 women (age range, 33-58 years). Three interval cancers were detected by self-examination, all in carriers of the BRCA1 mutation under age 43 years. One cancer was detected in a carrier of the BRCA1 mutation with a palpable abnormality in the contralateral breast. One incidental breast cancer was detected in a prophylactic mastectomy specimen. Respectively, sensitivity of DCE MR imaging, FFD mammography, and AB US was 68.1% (14 of 21; 95% confidence interval [CI]: 42.9%, 85.8%), 37.2% (eight of 21; 95% CI: 19.8%, 58.7%), and 32.1% (seven of 21; 95% CI: 16.1%, 53.8%); specificity was 95.0% (643 of 682; 95% CI: 92.7%, 96.5%), 98.1% (638 of 652; 95% CI: 96.7%, 98.9%), and 95.1% (1030 of 1088; 95% CI: 93.5%, 96.3%); cancer detection rate was 2.0% (14 of 702), 1.2% (eight of 671), and 1.0% (seven of 711) per 100 women-years; and positive predictive value was 25.2% (14 of 54), 33.7% (nine of 23), and 9.5% (seven of 68). DCE MR imaging and FFD mammography combined yielded the highest sensitivity of 76.3% (16 of 21; 95% CI: 53.8%, 89.9%) and specificity of 93.6% (643 of 691; 95% CI: 91.3%, 95.3%). AB US did not depict additional cancers. FFD mammography yielded no additional cancers in women younger than 43 years, the mean age at diagnosis. In carriers of the BRCA2 mutation, sensitivity of FFD mammography with DCE MR imaging surveillance was 90.9% (10 of 11; 95% CI: 72.7%, 100%) and 60.0% (six of 10; 95% CI: 30.0%, 90.0%) in carriers of the BRCA1 mutation because of the high interval cancer rate in carriers of the BRCA1 mutation. Conclusion AB US may not be of added value to yearly FFD mammography and DCE MR imaging surveillance of carriers of the BRCA mutation. Study results suggest that carriers of the BRCA mutation younger than 40 years may not benefit from FFD mammography surveillance in addition to DCE MR imaging. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jan C M van Zelst
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Roel D M Mus
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Gwendolyn Woldringh
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Matthieu J C M Rutten
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Peter Bult
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Suzan Vreemann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Mathijn de Jong
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nico Karssemeijer
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nicoline Hoogerbrugge
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Ritse M Mann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
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Belkić K, Cohen M, Wilczek B, Andersson S, Berman AH, Márquez M, Vukojević V, Mints M. Imaging surveillance programs for women at high breast cancer risk in Europe: Are women from ethnic minority groups adequately included? (Review). Int J Oncol 2015; 47:817-39. [PMID: 26134040 DOI: 10.3892/ijo.2015.3063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/02/2015] [Indexed: 11/06/2022] Open
Abstract
Women from ethnic minority groups, including immigrants and refugees are reported to have low breast cancer (BC) screening rates. Active, culturally-sensitive outreach is vital for increasing participation of these women in BC screening programs. Women at high BC risk and who belong to an ethnic minority group are of special concern. Such women could benefit from ongoing trials aimed at optimizing screening strategies for early BC detection among those at increased BC risk. Considering the marked disparities in BC survival in Europe and its enormous and dynamic ethnic diversity, these issues are extremely timely for Europe. We systematically reviewed the literature concerning European surveillance studies that had imaging in the protocol and that targeted women at high BC risk. The aim of the present review was thereby to assess the likelihood that women at high BC risk from minority ethnic groups were adequately included in these surveillance programs. Twenty-seven research groups in Europe reported on their imaging surveillance programs for women at increased BC risk. The benefit of strategies such as inclusion of magnetic resonance imaging and/or more intensive screening was clearly documented for the participating women at increased BC risk. However, none of the reports indicated that sufficient outreach was performed to ensure that women at increased BC risk from minority ethnic groups were adequately included in these surveillance programs. On the basis of this systematic review, we conclude that the specific screening needs of ethnic minority women at increased BC risk have not yet been met in Europe. Active, culturally-sensitive outreach is needed to identify minority women at increased BC risk and to facilitate their inclusion in on-going surveillance programs. It is anticipated that these efforts would be most effective if coordinated with the development of European-wide, population-based approaches to BC screening.
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Affiliation(s)
- Karen Belkić
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Miri Cohen
- University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Brigitte Wilczek
- Sankt Görans Hospital, Unilabs Department of Mammography, Stockholm, Sweden
| | - Sonia Andersson
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Anne H Berman
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Marcela Márquez
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Vladana Vukojević
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Miriam Mints
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
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9
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A Novel Approach to Contrast-Enhanced Breast Magnetic Resonance Imaging for Screening. Invest Radiol 2014; 49:579-85. [DOI: 10.1097/rli.0000000000000057] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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10
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Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, Eisen A, Meschino WS, Shumak RS, Warner E, Rabeneck L. Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program. J Clin Oncol 2014; 32:2224-30. [DOI: 10.1200/jco.2013.52.8331] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer. Patients and Methods Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously). Results The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%). Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.
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Affiliation(s)
- Anna M. Chiarelli
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Maegan V. Prummel
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Derek Muradali
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Vicky Majpruz
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Meaghan Horgan
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - June C. Carroll
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Andrea Eisen
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Wendy S. Meschino
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Rene S. Shumak
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Ellen Warner
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
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McBride KA, Ballinger ML, Killick E, Kirk J, Tattersall MHN, Eeles RA, Thomas DM, Mitchell G. Li-Fraumeni syndrome: cancer risk assessment and clinical management. Nat Rev Clin Oncol 2014; 11:260-71. [PMID: 24642672 DOI: 10.1038/nrclinonc.2014.41] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Carriers of germline mutations in the TP53 gene, encoding the cell-cycle regulator and tumour suppressor p53, have a markedly increased risk of cancer-related morbidity and mortality during both childhood and adulthood, and thus require appropriate and effective cancer risk management. However, the predisposition of such patients to multiorgan tumorigenesis presents a specific challenge for cancer risk management programmes. Herein, we review the clinical implications of germline mutations in TP53 and the evidence for cancer screening and prevention strategies in individuals carrying such mutations, as well as examining the potential psychosocial implications of lifelong management for a ubiquitous cancer risk. In addition, we propose an evidence-based framework for the clinical management of TP53 mutation carriers and provide a platform for addressing the management of other cancer predisposition syndromes that can affect multiple organs.
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Affiliation(s)
- Kate A McBride
- The Familial Cancer Service, Crown Princess Mary Cancer Centre, Sydney Medical School, Westmead Millennium Institute, Westmead, NSW 2145, Australia
| | - Mandy L Ballinger
- Research Division, Sir Peter MacCallum Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia
| | - Emma Killick
- Medical Oncology Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Judy Kirk
- The Familial Cancer Service, Crown Princess Mary Cancer Centre, Sydney Medical School, Westmead Millennium Institute, Westmead, NSW 2145, Australia
| | - Martin H N Tattersall
- Department of Cancer Medicine, Sydney Medical School, Royal Prince Alfred Hospital, Camperdown, NSW 2040, Australia
| | - Rosalind A Eeles
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - David M Thomas
- The Kinghorn Cancer Centre and Garvan Institute, Darlinghurst, NSW 2010, Australia
| | - Gillian Mitchell
- The Familial Cancer Centre, Sir Peter MacCallum Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia
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12
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Ingham SL, Sperrin M, Baildam A, Ross GL, Clayton R, Lalloo F, Buchan I, Howell A, Evans DGR. Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral. Breast Cancer Res Treat 2013; 142:611-8. [DOI: 10.1007/s10549-013-2765-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022]
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Schackmann EA, Munoz DF, Mills MA, Plevritis SK, Kurian AW. Feasibility evaluation of an online tool to guide decisions for BRCA1/2 mutation carriers. Fam Cancer 2013; 12:65-73. [PMID: 23086584 DOI: 10.1007/s10689-012-9577-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Women with BRCA1 or BRCA2 (BRCA1/2) mutations face difficult decisions about managing their high risks of breast and ovarian cancer. We developed an online tool to guide decisions about cancer risk reduction (available at: http://brcatool.stanford.edu ), and recruited patients and clinicians to test its feasibility. We developed questionnaires for women with BRCA1/2 mutations and clinicians involved in their care, incorporating the System Usability Scale (SUS) and the Center for Healthcare Evaluation Provider Satisfaction Questionnaire (CHCE-PSQ). We enrolled BRCA1/2 mutation carriers who were seen by local physicians or participating in a national advocacy organization, and we enrolled clinicians practicing at Stanford University and in the surrounding community. Forty BRCA1/2 mutation carriers and 16 clinicians participated. Both groups found the tool easy to use, with SUS scores of 82.5-85 on a scale of 1-100; we did not observe differences according to patient age or gene mutation. General satisfaction was high, with a mean score of 4.28 (standard deviation (SD) 0.96) for patients, and 4.38 (SD 0.89) for clinicians, on a scale of 1-5. Most patients (77.5 %) were comfortable using the tool at home. Both patients and clinicians agreed that the decision tool could improve patient-doctor encounters (mean scores 4.50 and 4.69, on a 1-5 scale). Patients and health care providers rated the decision tool highly on measures of usability and clinical relevance. These results will guide a larger study of the tool's impact on clinical decisions.
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Affiliation(s)
- Elizabeth A Schackmann
- Departments of Medicine and of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5405, USA
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14
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Ng AK, Garber JE, Diller LR, Birdwell RL, Feng Y, Neuberg DS, Silver B, Fisher DC, Marcus KJ, Mauch PM. Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma. J Clin Oncol 2013; 31:2282-8. [PMID: 23610104 DOI: 10.1200/jco.2012.46.5732] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Current guidelines recommend breast magnetic resonance imaging (MRI) as an adjunct to mammography for breast cancer screening in female cancer survivors treated with chest irradiation at a young age, beginning 8 to 10 years after treatment. Prospective data evaluating its efficacy in female cancer survivors are lacking. This study sought to compare the sensitivity and specificity of breast MRI with those of mammography in women who received chest irradiation for Hodgkin lymphoma (HL). PATIENTS AND METHODS We enrolled 148 women treated with chest irradiation for HL at age ≤ 35 years who were > 8 years beyond treatment. Yearly breast MRI and mammogram were performed over a 3-year period. Sensitivity and specificity of the two screening modalities were compared. RESULTS With the screening, 63 biopsies were performed in 45 women; 18 (29%) showed a malignancy. All but one of the screen-detected malignancies were preinvasive or subcentimeter node-negative breast cancers. After excluding first-screen MRI and mammogram, mammogram sensitivity was 68% as compared with 67% for MRI (P = 1.0). Sensitivity increased to 94% using both screening modalities. The specificities of mammogram alone, MRI alone, and both were 93%, 94%, and 90%, respectively. CONCLUSION In contrast to women with genetic or familial risk, in HL survivors breast MRI was not more sensitive than mammogram for breast cancer detection. However, the two screening modalities complement each other in the detection of early cases of disease. Early diagnosis is particularly important in these patients, given the breast cancer treatment challenges in patients who have received prior cancer therapy.
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Affiliation(s)
- Andrea K Ng
- Brigham and Women's Hospital, Boston, MA, USA.
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15
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Vencken PMLH, Kriege M, Hooning M, Menke-Pluymers MB, Heemskerk-Gerritsen BAM, van Doorn LC, Collée MM, Jager A, van Montfort C, Burger CW, Seynaeve C. The risk of primary and contralateral breast cancer after ovarian cancer in BRCA1/BRCA2 mutation carriers: Implications for counseling. Cancer 2012; 119:955-62. [PMID: 23165859 DOI: 10.1002/cncr.27839] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/03/2012] [Accepted: 08/10/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND The objective of this study was to assess the incidence of primary breast cancer (PBC) and contralateral breast cancer (CBC) in patients who had BRCA1/BRCA2-associated epithelial ovarian cancer (OC). METHODS From the database of the Rotterdam Family Cancer Clinic, patients who had BRCA-associated OC without a history of unilateral breast cancer (BC) (at risk of PBC; n = 79) or with a history of unilateral BC (at risk of CBC; n = 37) were selected. The control groups consisted of unaffected BRCA mutation carriers (n = 351) or mutation carriers who had a previous unilateral BC (n = 294), respectively. The risks of PBC and CBC were calculated using the Kaplan-Meier survival method with death considered as a competing risk event. RESULTS Women with BRCA-associated OC had lower 2-year, 5-year, and 10-year risks of PBC (3%, 6%, and 11%, respectively) compared with unaffected mutation carriers (6%, 16%, and 28%, respectively; P = .03), although they had a considerably higher mortality rate at similar time points (13%, 33%, and 61%, respectively, vs 1%, 2%, and 2%, respectively; P < .001). In BRCA mutation carriers with a previous unilateral BC, the 2-year, 5-year, and 10-year risks of CBC were nonsignificantly lower in patients with OC than in those without OC (0%, 7%, and 7%, respectively, vs 6%, 16%, and 34%, respectively; P = .06), whereas the mortality rate was higher in patients with OC (19%, 34%, and 55%, respectively, vs 4%, 11%, and 21%, respectively; P < .001). CONCLUSIONS Patients with BRCA-associated OC had a lower risk of developing a subsequent PBC or CBC than mutation carriers without OC, whereas the risk of dying from OC was greater than the risk of developing BC. These data may facilitate more tailored counseling for this patient subgroup, although confirmative studies are warranted.
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Affiliation(s)
- Peggy M L H Vencken
- Department of Gynecological Oncology, Family Cancer Clinic, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, the Netherlands
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16
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Evans DG, Howell A. Are We Ready for Online Tools in Decision Making for BRCA1/2 Mutation Carriers? J Clin Oncol 2012; 30:471-3. [DOI: 10.1200/jco.2011.40.1562] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- D. Gareth Evans
- The University of Manchester, Manchester Academic Health Science Centre, Central Manchester University Hospitals Foundation Trust, St. Mary's Hospital; and Genesis Prevention Centre, University Hospital of South Manchester, Wythenshawe, Manchester, United Kingdom
| | - Anthony Howell
- Genesis Prevention Centre, University Hospital of South Manchester, Wythenshawe, Manchester, United Kingdom
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Kurian AW, Munoz DF, Rust P, Schackmann EA, Smith M, Clarke L, Mills MA, Plevritis SK. Online tool to guide decisions for BRCA1/2 mutation carriers. J Clin Oncol 2012; 30:497-506. [PMID: 22231042 DOI: 10.1200/jco.2011.38.6060] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. A clinical decision tool could guide these complex choices. METHODS We built a Monte Carlo model for BRCA1/2 mutation carriers, simulating breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years and prophylactic mastectomy (PM) and/or prophylactic oophorectomy (PO) at various ages. Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. We adapted the model into an online tool to support shared decision making. RESULTS We compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To characterize patients' treatment and survivorship experiences, we reported the tumor features and treatments associated with risk-reducing interventions; for example, in most BRCA2 mutation carriers (81%), MRI screening diagnoses stage I, hormone receptor-positive breast cancers, which may not require chemotherapy. CONCLUSION Cancer risk-reducing options for BRCA1/2 mutation carriers vary in their impact on cancer incidence, recommended treatments, quality of life, and survival. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu).
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De Bock GH, Hesselink JW, Roorda C, De Vries J, Hollema H, Jaspers JP, Kok T, Werker PM, Oosterwijk JC, Mourits MJ. Model of care for women at increased risk of breast and ovarian cancer. Maturitas 2012; 71:3-5. [DOI: 10.1016/j.maturitas.2011.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 01/26/2023]
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Le-Petross HT, Shetty MK. Magnetic Resonance Imaging and Breast Ultrasonography as an Adjunct to Mammographic Screening in High-Risk Patients. Semin Ultrasound CT MR 2011; 32:266-72. [DOI: 10.1053/j.sult.2011.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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20
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Screening of high-risk groups for breast and ovarian cancer in Europe: a focus on the Jewish population. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0056-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers. Breast Cancer Res Treat 2010; 125:837-47. [PMID: 20644999 DOI: 10.1007/s10549-010-1043-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/02/2010] [Indexed: 12/19/2022]
Abstract
UNLABELLED Comparative effectiveness research has become an integral part of health care planning in most developed countries. In a simulated cohort of women, aged 30-65, who tested positive for BRCA1 or BRCA2 mutations, we compared outcomes of mammography with and without MRI, prophylactic oophorectomy with and without mastectomy, mastectomy alone, and chemoprevention. METHODS Using Treeage 9.02 software, we developed Markov models with 25,000 Monte Carlo simulations and conducted probabilistic sensitivity analysis. We based mutation penetrance rates, breast and ovarian cancer incidence, and mortality rates, and costs in terms of 2009 dollars, on published studies and data from the Surveillance, Epidemiology, and End RESULTS (SEER) Program and the Centers for Medicare and Medicaid Services. We used preference ratings obtained from mutation carriers and controls to adjust survival for quality of life (QALYs). RESULTS For BRCA1 mutation carriers, prophylactic oophorectomy at $1,741 per QALY, was more cost effective than both surgeries and dominated all other interventions. For BRCA2 carriers, prophylactic oophorectomy, at $4,587 per QALY, was more cost effective than both surgeries. Without quality adjustment, both mastectomy and BSO surgeries dominated all other interventions. In all simulations, preventive surgeries or chemoprevention dominated or were more cost effective than screening because screening modalities were costly. CONCLUSION Our analysis suggested that among BRCA1/2 mutation carriers, prophylactic surgery would dominate or be cost effective compared to chemoprevention and screening. Annual screening with MRI and mammography was the most effective strategy because it was associated with the longest quality-adjusted survival, but it was also very expensive.
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The Effectiveness of MR Imaging in the Assessment of Invasive Lobular Carcinoma of the Breast. Magn Reson Imaging Clin N Am 2010; 18:259-76, ix. [DOI: 10.1016/j.mric.2010.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chéreau E, Uzan C, Balleyguier C, Chevalier J, de Paillerets BB, Caron O, Rimareix F, Mathieu MC, Koskas M, Bourgier C, André F, Dromain C, Delaloge S. Characteristics, Treatment, and Outcome of Breast Cancers Diagnosed in BRCA1 and BRCA2 Gene Mutation Carriers in Intensive Screening Programs Including Magnetic Resonance Imaging. Clin Breast Cancer 2010; 10:113-8. [DOI: 10.3816/cbc.2010.n.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Current Guidelines and Best Practice Evidence for Intensified/Enhanced Breast Cancer Screening in Women with BRCA Mutations. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Heywang-Köbrunner SH, Schreer I, Heindel W, Katalinic A. Imaging studies for the early detection of breast cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:541-7. [PMID: 19593396 PMCID: PMC2696953 DOI: 10.3238/arztebl.2008.0541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 03/31/2008] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The effectiveness of mammographic screening has been proven at evidence level 1A. Mammography offers the best ratio of benefits to side effects of any screening method tested to date. In this literature review, we ask whether early detection might be improved still further by combining mammography with other imaging modalities. METHODS The authors performed a selective literature search for combined key words in the Medline and Cochrane Library databases from 1/2000 to 11/2007, screened all titles, and evaluated the full text of all original articles. We selected articles for further analysis according to systematic criteria (minimum numbers, avoidance of overlap) and also considered published guidelines. RESULTS No screening studies of comparable size to those for mammography are available for ultrasound or MRI. Smaller studies have indicated that the use of these two modalities might lead to the detection of additional cancers in selected subgroups. For mass screening an increase in the detection rate of 10% to 15% might become possible. This increase would probably be associated with a tripling of the breast biopsy rate, compared to mammography alone. The number of indeterminate cases in which short-term follow-up (i.e., at 6 months) would be recommended would increase roughly tenfold with MRI, and to an unknown extent with ultrasound. The related quality-assurance issues remain to be addressed. DISCUSSION Randomized controlled studies are needed for a realistic assessment of the achievable benefits and unavoidable side effects of combined screening. For women whose risk of breast cancer is not elevated, mammography remains the standard screening method.
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Veltman J, Mann R, Kok T, Obdeijn IM, Hoogerbrugge N, Blickman JG, Boetes C. Breast tumor characteristics of BRCA1 and BRCA2 gene mutation carriers on MRI. Eur Radiol 2008; 18:931-8. [PMID: 18270717 PMCID: PMC2292493 DOI: 10.1007/s00330-008-0851-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 11/07/2007] [Accepted: 12/18/2007] [Indexed: 12/12/2022]
Abstract
The appearance of malignant lesions in BRCA1 and BRCA2 mutation carriers (BRCA-MCs) on mammography and magnetic resonance imaging (MRI) was evaluated. Thus, 29 BRCA-MCs with breast cancer were retrospectively evaluated and the results compared with an age, tumor size and tumor type matched control group of 29 sporadic breast cancer cases. Detection rates on both modalities were evaluated. Tumors were analyzed on morphology, density (mammography), enhancement pattern and kinetics (MRI). Overall detection was significantly better with MRI than with mammography (55/58 vs 44/57, P = 0.021). On mammography, lesions in the BRCA-MC group were significantly more described as rounded (12//19 vs 3/13, P = 0.036) and with sharp margins (9/19 vs 1/13, P = 0.024). On MRI lesions in the BRCA-MC group were significantly more described as rounded (16/27 vs 7/28, P = 0.010), with sharp margins (20/27 vs 7/28, P < 0.001) and with rim enhancement (7/27 vs 1/28, P = 0.025). No significant difference was found for enhancement kinetics (P = 0.667). Malignant lesions in BRCA-MC frequently have morphological characteristics commonly seen in benign lesions, like a rounded shape or sharp margins. This applies for both mammography and MRI. However the possibility of MRI to evaluate the enhancement pattern and kinetics enables the detection of characteristics suggestive for a malignancy.
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Affiliation(s)
- J Veltman
- 430 Department of Radiology, University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Hartman M, Lindström L, Dickman PW, Adami HO, Hall P, Czene K. Is breast cancer prognosis inherited? Breast Cancer Res 2007; 9:R39. [PMID: 17598882 PMCID: PMC1929105 DOI: 10.1186/bcr1737] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 04/25/2007] [Accepted: 06/28/2007] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A genetic component is well established in the etiology of breast cancer. It is not well known, however, whether genetic traits also influence prognostic features of the malignant phenotype. METHODS We carried out a population-based cohort study in Sweden based on the nationwide Multi-Generation Register. Among all women with breast cancer diagnosed from 1961 to 2001, 2,787 mother-daughter pairs and 831 sister pairs with breast cancer were identified; we achieved complete follow-up and classified 5-year breast cancer-specific prognosis among proband (mother or oldest sister) into tertiles as poor, intermediary, or good. We used Kaplan-Meier estimates of survival proportions and Cox models to calculate relative risks of dying from breast cancer within 5 years depending on the proband's outcome. RESULTS The 5-year survival proportion among daughters whose mothers died within 5 years was 87% compared to 91% if the mother was alive (p = 0.03). Among sisters, the corresponding proportions were 70% and 88%, respectively (p = 0.001). After adjustment for potential confounders, daughters and sisters of a proband with poor prognosis had a 60% higher 5-year breast cancer mortality compared to those of a proband with good prognosis (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.2 to 2.2; p for trend 0.002). This association was slightly stronger among sisters (HR, 1.8; 95% CI, 1.0 to 3.4) than among daughters (HR, 1.6; 95% CI, 1.1 to 2.3). CONCLUSION Breast cancer prognosis of a woman predicts the survival in her first-degree relatives with breast cancer. Our novel findings suggest that breast cancer prognosis might be inherited.
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Affiliation(s)
- Mikael Hartman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
- Stockholm Söder Hospital, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Linda Lindström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
- Department of Epidemiology, Harvard University, 677 Huntington Avenue, Boston, 02115 MA, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P. O. Box 281, 171 77 Stockholm, Sweden
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Colin C, Prince V. Modalités de dépistage radiologique devant un risque familial identifié de cancer du sein. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)92168-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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