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Ferretti S, Sassoli de Bianchi P, Canuti D, Campari C, Cortesi L, Arcangeli V, Barbieri E, D'Aloia C, Danesi R, De Iaco P, De Lillo M, Lombardo L, Moretti G, Musolino A, Palli D, Palmonari C, Ravegnani M, Tafà A, Tononi A, Turchetti D, Zamagni C, Zampiga V, Bucchi L, The Hboc Study Group. Evaluation of an Italian Population-Based Programme for Risk Assessment and Genetic Counselling and Testing for BRCA1/2-Related Hereditary Breast and Ovarian Cancer after 10 Years of Operation: An Observational Study Protocol. Methods Protoc 2024; 7:63. [PMID: 39195440 DOI: 10.3390/mps7040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Hereditary breast/ovarian cancer (HBOC) syndrome is caused by the inheritance of monoallelic germline BRCA1/2 gene mutations. If BRCA1/2 mutation carriers are identified before the disease develops, effective actions against HBOC can be taken, including intensive screening, risk-reducing mastectomy and salpingo-oophorectomy, and risk-reducing medications. The Italian National Prevention Plan mandates the creation of regional BRCA genetic testing programmes. So far, however, only informal data have been reported on their implementation. We have designed a study aimed at evaluating the results of a population-based programme for risk assessment and genetic counselling and testing for BRCA1/2-related HBOC that is underway in the Emilia-Romagna region (northern Italy). The programme-which is entirely free-includes basic screening with an estimate of the likelihood of carrying a BRCA1/2 mutation using a familial risk assessment tool, a closer examination of women with suspected risk increase, an assessment of the need for further genetic counselling and, if needed, genetic testing and risk-reducing interventions. In this paper, the design of the programme and the protocol of the study are presented. The study has an observational, historical cohort design. Eligible are the women found to be at an increased risk of HBOC (profile 3 women). The main objectives are (i) to determine the precision of the programme in measuring the level of risk of HBOC for profile 3 women; (ii) to determine the characteristics of profile 3 women and their association with the risk management strategy chosen; (iii) to compare the age at onset, histologic type, tumour stage, molecular subtype, and prognosis of breast/ovarian cancers observed in the cohort of profile 3 women with the features of sporadic cancers observed in the general female population; (iv) to determine the level and the determinants of adherence to recommendations; and (v) to determine the appropriateness and timing of risk-reducing surgery and medications. Investigating the quality and results of the programme is necessary because the best practices in risk assessment and genetic counselling and testing for BRCA1/2-related cancer and the challenges they encounter should be identified and shared. The study has the potential to provide sound empirical evidence for the factors affecting the effectiveness of this type of service.
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Affiliation(s)
- Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
- Local Health Authority, 44121 Ferrara, Italy
| | | | - Debora Canuti
- Department of Health, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Cinzia Campari
- Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Laura Cortesi
- Struttura di Genetica Oncologica, Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Valentina Arcangeli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Elena Barbieri
- Struttura di Oncologia, Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Cecilia D'Aloia
- Section of Radiology and Breast Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Rita Danesi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Medical Oncology, Breast Unit and Cancer Genetics Service, University Hospital of Parma, 43126 Parma, Italy
| | - Dante Palli
- UOC Chirurgia Generale a Indirizzo Senologico and Breast Unit, 29121 Piacenza, Italy
| | - Caterina Palmonari
- Cancer Screening Centre and Spoke Centre, AUSL Ferrara, 44121 Ferrara, Italy
| | - Mila Ravegnani
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Alfredo Tafà
- UOC Senologia, Ospedale Bellaria, AUSL Bologna, 40139 Bologna, Italy
| | - Alessandra Tononi
- Unità Operativa di Prevenzione Oncologica, Ospedale Infermi, 47923 Rimini, Italy
| | - Daniela Turchetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Zampiga
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
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Menes TS, Zippel D, Sklair-Levy M, Friedman E, Bernstein-Molho R, Faermann R, Madorsky Feldman D. Clinical breast exam contribution to breast cancer diagnosis in BRCA mutation carriers vs. average to intermediate risk women. Breast Cancer Res Treat 2024; 207:111-118. [PMID: 38797791 PMCID: PMC11230960 DOI: 10.1007/s10549-024-07345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The contribution of clinical breast exam (CBE) to breast cancer diagnosis in average risk women undergoing regular screening mammography is minimal. To evaluate the role of CBE in high-risk women, we compared BC diagnosis by CBE in BRCA mutation carriers undergoing regular BC surveillance to average to intermediate risk women undergoing regular breast cancer screening. METHODS A retrospective chart review of all consecutive screening visits of BRCA mutation carriers (January 2012-October 2022) and average to intermediate risk women (November 2016-December 2022) was completed. Women with histologically confirmed BC diagnosis were included. Additional CBE yield for BC diagnosis, defined as the percentage of all BC cases detected by CBE alone, was assessed in both groups. RESULTS Overall, 12,997 CBEs were performed in 1,328 BRCA mutation carriers in whom 134 BCs were diagnosed. In 7,949 average to intermediate risk women who underwent 15,518 CBEs, 87 BCs were diagnosed. CBE contributed to BC diagnosis in 3 (2%) BRCA mutation carriers and 3 (4%) non-carriers. In both groups, over 4,000 CBEs were needed in order to diagnose one cancer. In all 3 BRCA mutation carriers BC was palpated during the surveillance round that did not include MRI. In the average to intermediate risk group, 2 of 3 cancers diagnosed following CBE findings were in a different location from the palpable finding. CONCLUSIONS The contribution of CBE to BC diagnosis is marginal for all women including BRCA mutation carriers. In BRCA mutation carriers, CBE appears redundant during the MRI surveillance round.
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Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Sheba Medical Center, Ramat Gan, Israel.
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Douglas Zippel
- Department of Surgery, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Miri Sklair-Levy
- Meirav Center for Women's Health and High-Risk Clinic, Sheba Medical Center, Ramat Gan, Israel
- Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eitan Friedman
- Meirav Center for Women's Health and High-Risk Clinic, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Rinat Bernstein-Molho
- Meirav Center for Women's Health and High-Risk Clinic, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Renata Faermann
- Meirav Center for Women's Health and High-Risk Clinic, Sheba Medical Center, Ramat Gan, Israel
- Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dana Madorsky Feldman
- Meirav Center for Women's Health and High-Risk Clinic, Sheba Medical Center, Ramat Gan, Israel
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Sorin V, Bufman H, Bernstein-Molho R, Faermann R, Friedman E, Raskin D, Balint Lahat N, Sklair-Levy M. Breast cancer screening in BRCA1/2 pathogenic sequence variant carriers during pregnancy and lactation. Clin Imaging 2024; 111:110189. [PMID: 38759599 DOI: 10.1016/j.clinimag.2024.110189] [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] [Received: 03/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women harboring germline BRCA1/BRCA2 pathogenic sequence variants (PSVs) are at an increased risk for breast cancer. There are no established guidelines for screening during pregnancy and lactation in BRCA carriers. The aim of this study was to evaluate the utility of whole-breast ultrasound (US) screening in pregnant and lactating BRCA PSV carriers. METHODS Data were retrospectively collected from medical records of BRCA PSV carriers between 2014 and 2020, with follow-up until 2021. Associations between imaging intervals, number of examinations performed and pregnancy-associated breast cancers (PABCs) were examined. PABCs and cancers diagnosed at follow-up were evaluated and characteristics were compared between the two groups. RESULTS Overall 212 BRCA PSV carriers were included. Mean age was 33.6 years (SD 3.93, range 25-43 years). During 274 screening periods at pregnancy and lactation, eight (2.9 %) PABCs were diagnosed. An additional eight cancers were diagnosed at follow-up. Three out of eight (37.5 %) PABCs were diagnosed by US, whereas clinical breast examination (n = 3), mammography (n = 1) and MRI (n = 1) accounted for the other PACB diagnoses. One PABC was missed by US. The interval from negative imaging to cancer diagnosis was significantly shorter for PABCs compared with cancers diagnosed at follow-up (3.96 ± 2.14 vs. 11.2 ± 4.46 months, P = 0.002). CONCLUSION In conclusion, pregnant BRCA PSV carriers should not delay screening despite challenges like altered breast tissue and hesitancy towards mammography. If no alternatives exist, whole-breast ultrasound can be used. For lactating and postpartum women, a regular screening routine alternating between mammography and MRI is recommended.
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Affiliation(s)
- Vera Sorin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel.
| | - Hila Bufman
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Rinat Bernstein-Molho
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Renata Faermann
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Eitan Friedman
- The Faculty of Medicine, Tel-Aviv University, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel Raskin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Nora Balint Lahat
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
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Bufman H, Faermann R, Halshtok-Neiman O, Shalmon A, Gotlieb M, Samoocha D, Yagil Y, Feldman DM, Friedman E, Sklair-Levy M. Breast cancer diagnosed after age 70 years in Israeli BRCA1/BRCA2 pathogenic sequence variant carriers: a single institution experience. Breast Cancer Res Treat 2024; 205:281-285. [PMID: 38379091 PMCID: PMC11101537 DOI: 10.1007/s10549-023-07234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE A semi-annual surveillance scheme from age 25 to 30 years is offered to BRCA1/BRCA2 pathogenic sequence variants (PSVs) carriers for early detection of breast cancer (BC). There is a paucity of data on the yield of adhering to this scheme beyond 70 years of age. METHODS Female BRCA1/BRCA2 PSV carriers followed at the Meirav high-risk clinic, Sheba Medical center, Israel were eligible. Type and frequencies if use of Imaging modalities, breast biopsies and histological outcomes for participants after age 70 years were retrieved and analyzed. RESULTS Overall, the study encompassed 88 consenting participants (46 BRCA1 carriers) mean age ± SD 73.7 ± 3.3 years (range 70-90 years), followed for an average of 3.8 years (range 1-11 years). Ten carriers (11.3%) were diagnosed with BC after age 70 years (mean age at diagnosis 72 ± 2 years) and an additional case was diagnosed with breast lymphoma. The imaging modality that has led to most diagnoses was MRI (8/11 cases). Eight of these ten cases were previously diagnosed with BC prior to age 70 and in six, BC past 70 years was in the contralateral breast. The lesions size averaged 1.29 ± 0.75 cm, with IDC and DCIS diagnosed in five cases each, and none had lymph node involvement. CONCLUSION In ~10% of BRCA1/BRCA2 PSV carriers BC is diagnosed by breast imaging after age 70 years. If these results are validated in a larger study, the guidelines for the maximum age for BC surveillance in high risk women should be revisited and set at 75 years.
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Affiliation(s)
- Hila Bufman
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
| | - Renata Faermann
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | - Osnat Halshtok-Neiman
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | - Anat Shalmon
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Gotlieb
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | - David Samoocha
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Yagil
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Eitan Friedman
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel
- The School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Center for Personalized Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Miri Sklair-Levy
- The Institute of Radiology, Sheba Medical Center, 1 Emek Ha-Ella St, 5265601, Tel-Hashomer, Israel.
- The Meirav High Risk Clinic, Sheba Medical Center, Tel-Hashomer, Israel.
- The School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bertozzi S, Londero AP, Xholli A, Azioni G, Di Vora R, Paudice M, Bucimazza I, Cedolini C, Cagnacci A. Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review. J Clin Med 2023; 12:jcm12041422. [PMID: 36835955 PMCID: PMC9967164 DOI: 10.3390/jcm12041422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review's scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
| | - Ambrogio P. Londero
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy
- Correspondence:
| | - Anjeza Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Guglielmo Azioni
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Roberta Di Vora
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
| | - Michele Paudice
- Anatomic Pathology Unit, Department of Surgical Sciences, and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, GE, Italy
- Anatomic Pathology Unit, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Ines Bucimazza
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban 4001, South Africa
| | - Carla Cedolini
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
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Faermann R, Friedman E, Kaidar-Person O, Brodsky M, Neiman OH, Shalmon A, Gotlieb M, Yagil Y, Samocha D, Feldman DM, Weidenfeld J, Sklair-Levy M. Pregnancy Associated Breast Cancer Among Israeli BRCA1/BRCA2 Carriers in a High-Risk Clinic. Acad Radiol 2023; 30:248-254. [PMID: 35527100 DOI: 10.1016/j.acra.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Female carriers of pathogenic sequence variants (PSVs) in the BRCA1 /BRCA2 (Breast Cancer gene - BRCA) genes are at a substantially high-risk for developing breast cancer (BC), hence are offered active surveillance scheme based on semiannual breast exam and imaging from age 25 years to facilitate BC early detection (mammography/breast ultrasound depending on the age, and MRI). However, there are not specific guidelines for screening in case of pregnancy or lactation. In the current study, we summarize the experience at the largest high-risk clinic in Israel. MATERIALS AND METHODS Data of consecutive BRCA-PSV carriers undergoing surveillance as well as diagnostic ultrasound at the Meirav high-risk clinic from January 2014 to 2021 who were pregnant and/or breastfeeding at time of follow-up were identified. Relevant clinical data including results of breast exam, breast ultrasonography, biopsies and histological results were retrieved. Percentage of biopsies with malignancy, cancer detection rate and positive predictive values were calculated. Data is presented in descriptive statistics. RESULTS A total of 263 BRCA-carriers were included. Of these, 593 breast-ultrasonograms were performed in 263 BRCA-carriers for 292 pregnancies and 409 breast-ultrasonograms for 175 breastfeeding carriers. Of 36 breast biopsies in 292 pregnancies, 4 (PPV = 11%) had BC diagnosed (high grade invasive). Of 175 breastfeeding women, 25 biopsies were performed and 2 (PPV = 8%) were high grade invasive BC. Five of 6 BC were diagnosed in BRCA1 carriers, and 4/6 were screen detected. The rate of pregnancy-associated breast cancer was 6/292 (2.05%). CONCLUSION The overall detection rate of pregnancy-associated BC in BRCA-carriers is relatively low (2.05%), but still much higher than that in the general population. Two thirds of the BC were detected by screening. Therefore, despite the changes of the glandular breast tissue at time of pregnancy and breastfeeding, screening plays an important role in early detection. Ultrasound should be considered as a screening tool during this period of life of high-risk patients.
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Affiliation(s)
- Renata Faermann
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel.
| | - Eitan Friedman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Orit Kaidar-Person
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Malka Brodsky
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Osnat Halshtok Neiman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Anat Shalmon
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Michael Gotlieb
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Yael Yagil
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - David Samocha
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Dana Madorsky Feldman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Jonathan Weidenfeld
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Miri Sklair-Levy
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
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7
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Bernstein-Molho R, Friedman E, Evron E. Controversies and Open Questions in Management of Cancer-Free Carriers of Germline Pathogenic Variants in BRCA1/BRCA2. Cancers (Basel) 2022; 14:cancers14194592. [PMID: 36230512 PMCID: PMC9559251 DOI: 10.3390/cancers14194592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Females harboring germline BRCA1/BRCA2 (BRCA) P/LPV are offered a tight surveillance scheme from the age of 25−30 years, aimed at early detection of specific cancer types, in addition to risk-reducing strategies. Multiple national and international surveillance guidelines have been published and updated over the last two decades from geographically diverse countries. We searched for guidelines published between 1 January 2015 and 1 May 2022. Differences between guidelines on issues such as primary prevention, mammography screening in young (<30 years) carriers, MRI screening in carriers above age 65 years, breast imaging (if any) after risk-reducing bilateral mastectomy, during pregnancy, and breastfeeding, and hormone-replacement therapy, are just a few notable examples. Beyond formal guidelines, BRCA carriers’ concerns also focus on the timing of risk-reducing surgeries, fertility preservation, management of menopausal symptoms in cancer survivors, and pancreatic cancer surveillance, issues that, for some, there are no data to support evidence-based recommendations. This review discusses these unsettled issues, emphasizing the importance of future studies to enable global guideline harmonization for optimal surveillance strategies. Moreover, it raises the unmet need for personalized risk stratification and surveillance in BRCA P/LPV carriers.
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Affiliation(s)
- Rinat Bernstein-Molho
- The Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 5265601, Israel
| | - Eitan Friedman
- Assuta Medical Center, Tel-Aviv, Israel, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 8436322, Israel
| | - Ella Evron
- Oncology, Kaplan Medical Institute, Rehovot, Hadassah Medical School, The Hebrew University, Jerusalem 9190501, Israel
- Correspondence: or ; Tel.: +972-502-056-171
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8
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Radiologic screening and surveillance in hereditary cancers. Eur J Radiol Open 2022; 9:100422. [PMID: 35874798 PMCID: PMC9301608 DOI: 10.1016/j.ejro.2022.100422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 12/30/2022] Open
Abstract
Hereditary cancer syndromes comprise an important subset of cancers caused by pathogenic germline mutations that can affect various organ systems. Radiologic screening and surveillance for solid tumors has emerged as a critical component of patient management in permitting early cancer detection. Although imaging surveillance may be tailored for organ-specific cancer risks, surveillance protocols frequently utilize whole-body MRI or PET/CT because of their ability to identify neoplasms in different anatomic regions in a single exam. In this review, we discuss the basic tenets of imaging screening and surveillance strategies in these syndromes, highlighting the more common neoplasms and their associated multimodality imaging findings. Pathogenic germline mutations in hereditary cancers cause early-onset distinctive tumors in an organ-specific pattern. Geneticist, oncologist, and radiologist coordination facilitates syndrome-appropriate screening and surveillance strategies. WB-MRI is a promising comprehensive non-ionizing screening/surveillance modality but with sparse prospective survival data.
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9
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Landau C, Novak AM, Ganz AB, Rolnik B, Friedman E, Lev-Ari S. Effect of Inquiry-Based Stress Reduction on Well-being and Views on Risk-Reducing Surgery Among Women With BRCA Variants in Israel: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2139670. [PMID: 34962562 PMCID: PMC8715352 DOI: 10.1001/jamanetworkopen.2021.39670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE The high risk for breast and ovarian cancers conferred by being a carrier of BRCA1 or BRCA2 germline variant can negatively impact physical and psychological well-being. Novel nonpharmacological interventions on well-being in women with BRCA variants have rarely been reported. OBJECTIVE To determine the effect of a 12-week inquiry-based stress reduction (IBSR) program on psychological well-being, sleep quality, psychosocial variables, and attitudes toward risk-reducing surgical procedures among women in Israel who carried BRCA variants. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial had a 12-week intervention period and a 12-week follow-up period. It was conducted between April 1, 2017, and July 31, 2020. Participants were recruited from the Meirav Breast Center at the Sheba Medical Center, Israel, and the intervention was conducted in Tel Aviv, Israel. The cohort included women with BRCA variants. Data were analyzed from August 1 to December 1, 2020. INTERVENTIONS Women were randomly assigned to the 12-week IBSR program or standard care. The IBSR technique is based on the skills of mindfulness, inquiry, and cognitive reframing. The intervention included standardized, weekly group meetings conducted throughout 12 weeks. Standard care included semi-annual breast examinations and breast magnetic resonance imaging (alternating), a gynecological examination, a transvaginal ultrasonographic examination, and CA-125 serum determination. Differences between the groups were tested using mixed-effects models in an intent to treat analysis. MAIN OUTCOMES AND MEASURES The primary outcome was psychological well-being, including 6 parameters: autonomy, personal growth, positive relationships, control of the environment, goals in life, and self-acceptance. Secondary outcomes included sleep quality, attitudes toward risk-reducing surgical procedures, and psychosocial variables. Questionnaires were administered at baseline (T1), at completion of the 12-week intervention (T2), and 12 weeks after completion of the intervention (T3). RESULTS Overall, 100 women (mean [SD] age, 41.37 [11.06] years) completed the study, with 50 randomized to the intervention group and 50 randomized to the control group. Mean (SD) time from variant discovery was 4.7 (3.3) years. There were no differences between the intervention and control groups in baseline mean (SD) scores of psychological well-being parameters (autonomy: 55.20 [11.12] vs 56.77 [9.90]; environmental control: 56.30 [11.98 vs 58.51 [11.41]; positive relationships: 63.10 [15.91] vs 68.10 [9.86]; goals in life: 60.00 [14.12] vs 64.82 [10.57]; self-acceptance: 55.02 [16.62] vs 60.32 [13.50]) except personal growth (63.70 [14.66] vs 68.85 [8.07]). The IBSR group, compared with the control group, experienced better mean (SD) scores on all psychological well-being parameters at T2 (autonomy: 63.64 [8.35] vs 54.73 [10.41]; environmental control: 63.95 [10.05] vs 57.45 [11.43]; personal growth: 73.00 [8.34] vs 65.76 [10.95]; positive relationships 71.17 [9.99] vs 65.06 [12.58]; goals in life: 67.57 [8.88] vs 61.18 [12.87]; self-acceptance: 66.93 [11.15] vs 58.09 [15.55]) and at T3 (autonomy: 62.68 [9.05] vs 56.12 [10.64]; environmental control: 64.55 [10.28] vs 59.35 [12.98]; personal growth: 72.00 [8.06] vs 67.15 [11.82]; positive relationships: 71.24 [9.78] vs 66.92 [12.37]; goals in life: 68.33 [8.54] vs 62.92 [13.24]; self-acceptance: 66.84 [11.35] vs 58.97 [17.03]). Individuals in the IBSR group also experienced statistically significant improvements in sleep quality (mean [SD]: T1, 7.35 [3.97]; T3, 4.63 [3.21], P < .001), whereas the control group experienced no statistically significant difference. Women in the intervention group had a more favorable consideration of risk-reducing oophorectomy, from 7 women (14%) who refused to consider oophorectomy at T1 to 1 woman (2%) who refused to consider it at T3 (P = .04), and similar change in consideration of mastectomy: from 23 women (46%) who refused to consider mastectomy at T1 to 13 women (29%) who refused to consider it at T3 (P < .001). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that IBSR improved psychological well-being and led to a more favorable view on risk-reducing surgical procedures for at least 6 months among women in Israel who carried BRCA variants. These results suggest that IBSR may be implemented as a self-practice tool to enhance the well-being of individuals who carry BRCA variants and support them in their decision-making processes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03162276.
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Affiliation(s)
- Carla Landau
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anne Marie Novak
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel B. Ganz
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Benjamin Rolnik
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Eitan Friedman
- Suzanne Levy-Gertner Oncogenetics Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Shahar Lev-Ari
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Ex Vivo Study of Artifacts Caused by Breast Tissue Markers with Different 1.5 Tesla and 3 Tesla MRI Scanners - A Bicentric Study. Acad Radiol 2021; 28:77-84. [PMID: 32008930 DOI: 10.1016/j.acra.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of our study was to evaluate magnetic resonance (MR) artifacts related to breast tissue markers in breast imaging procedures. MATERIALS AND METHODS In this bicentric prospective ex vivo study 10 different commercially available markers were measured in self-made breast phantoms. Breast tissue markers varying in marker size, composition, and shape were evaluated. MR imaging (MRI) scans were performed on 1.5 Tesla (T) and 3 T scanners from 2 different vendors, using dedicated breast coils. Three different sequences (T1-weighted images with and without fat saturation, T2-weighted images) were acquired in axial and coronal view. Three blinded readers electronically measured the artifact length. RESULTS All markers caused artifacts in MRI. The largest median artifact length was 10.4 mm, interquartile range (IQR 9.4-11.0 mm), the smallest 4.8 mm (IQR 4.5-5.2 mm). Relative artifact length (quotient artifact length in mm/real physical length of the marker) ranged between 0.9 (IQR 0.9-1.2) and 3.0 (IQR 2.8-3.4). Mean artifact length was higher for metallic markers (10.2 mm; IQR 8.7-11.5 mm) compared to metallic markers with nonmetallic coating (7.7 mm; IQR 6.3-10.2 mm) and nonmetallic marker (7.6 mm; IQR 5.9-10.0 mm); all p < 0.0001. Artifact size was higher in coronal in comparison to axial view; p < 0.05. The results were comparable between the different field strengths, the sites and sequences; p > 0.05. Interobserver agreement was excellent (ntraclass correlation coefficient = 0.83). CONCLUSION Artifacts are necessary in the detection and localization of breast tissue markers, but could also limit the interpretation of MRI due to the possibility of masking the residual tumor after biopsy. This artifact size varies among the different clips evaluated. It depends on marker composition and scan direction but is not influenced by image sequence, field strength or scanner type.
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11
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Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Incidence and Risk Factors of Ovarian Cancer and Breast Cancer Following Prophylactic Surgery: A Retrospective Cohort Study. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, López Ruiz A. Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020; 62:417-433. [PMID: 32527577 DOI: 10.1016/j.rx.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A López Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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14
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Metcalfe K, Eisen A, Senter L, Armel S, Bordeleau L, Meschino WS, Pal T, Lynch HT, Tung NM, Kwong A, Ainsworth P, Karlan B, Moller P, Eng C, Weitzel JN, Sun P, Lubinski J, Narod SA. International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation. Br J Cancer 2019; 121:15-21. [PMID: 30971774 PMCID: PMC6738089 DOI: 10.1038/s41416-019-0446-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Women with a BRCA1 or BRCA2 mutation face high risks of breast and ovarian cancer. In the current study, we report on uptake of cancer screening and risk-reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017). METHODS Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered. RESULTS Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy and 64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country. CONCLUSION For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.
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Affiliation(s)
- Kelly Metcalfe
- Women's College Research Institute, Toronto, ON, Canada.,Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Leigha Senter
- Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan Armel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | | | - Tuya Pal
- Vanderbilt-Ingram Cancer Center/Vanderbilt University Medical Center, Nashville, TN, USA
| | - Henry T Lynch
- Hereditary Cancer Center, Creighton University School of Medicine, Omaha, NE, USA
| | - Nadine M Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR.,Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.,Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong SAR
| | - Peter Ainsworth
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Beth Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Pal Moller
- Research Group Inherited Cancer, Department of Medical, Genetics, Oslo University Hospital, Oslo, Norway.,Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Oslo, Norway.,Center for Hereditary Tumors, HELIOS-Klinikum Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Charis Eng
- Genomic Medicine Institute, Center for Personalised Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ping Sun
- Women's College Research Institute, Toronto, ON, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A Narod
- Women's College Research Institute, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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15
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Collet G, Parodi N, Cassinari K, Neviere Z, Cohen F, Gasnier C, Brahimi A, Lecoquierre F, Thery JC, Tennevet I, Lacaze E, Berthet P, Frebourg T. Cost-effectiveness evaluation of pre-counseling telephone interviews before face-to-face genetic counseling in cancer genetics. Fam Cancer 2019; 17:451-457. [PMID: 29080081 DOI: 10.1007/s10689-017-0049-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the main challenges in cancer genetics is responding to the exponential demand for genetic counseling, especially in patients with breast and/or ovarian cancer. To address this demand, we have set up a new procedure, based on pre-genetic counseling telephone interviews (PTI) followed by routing of patients: D1, a PTI is scheduled within 14 days; D7-D14, genetic counselors perform a 20 min PTI in order to establish a pre-genetic counseling file, by collecting personal and family medical history via a structured questionnaire and; D10-17, routing: pre-genetic counseling appointment files are analyzed by a cancer geneticist with 3 possible conclusions: (a) priority face-to-face genetic counseling (FTFGC) appointment with a cancer geneticist, if the genetic test results have an immediate therapeutic impact; (b) non-priority FTFGC with a genetic counselor, or (c) no FTFGC required or substitution by a more appropriate index case. In the context of breast and/or ovarian cancer, 1012 patients received PTIs, 39.1% of which did not lead to FTFGC. The mean delay for non-priority FTFGC was maintained at 18 weeks and priority FTFGC appointments were guaranteed within 8 weeks. The required resources for 1012 patients was estimated at 0.12 FTE secretaries, 0.62 FTE genetic counselors and 0.08 FTE cancer geneticists and the procedure was shown to be cost-effective. This new procedure allows the suppression of up to 1/3 of appointments, guarantees priority for appointments with therapeutic impact and optimizes the interaction and breakdown of tasks between genetic counselors and cancer geneticists.
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Affiliation(s)
- Gaëlle Collet
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Nathalie Parodi
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Kevin Cassinari
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Zoe Neviere
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Fanny Cohen
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Céline Gasnier
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Afane Brahimi
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - François Lecoquierre
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Jean-Christophe Thery
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Oncology, Comprehensive Cancer Centre Henri Becquerel, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Isabelle Tennevet
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Oncology, Comprehensive Cancer Centre Henri Becquerel, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Elodie Lacaze
- Department of Genetics, Le Havre General Hospital, Normandy Centre for Genomic and Personalized Medicine, 76600, Le Havre, France
| | - Pascaline Berthet
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Thierry Frebourg
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France.
- Department of Genetics, Rouen University Hospital, 22 boulevard Gambetta, 76183, Rouen Cedex 1, France.
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16
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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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17
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Golan O, Amitai Y, Barnea Y, Menes TS. Yield of surveillance magnetic resonance imaging after bilateral mastectomy and reconstruction: a retrospective cohort study. Breast Cancer Res Treat 2018; 174:463-468. [PMID: 30511241 DOI: 10.1007/s10549-018-05077-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE There are no evidence-based guidelines for surveillance of women after bilateral mastectomy and reconstruction. Several societies recommend against routine breast imaging in this setting. Despite these recommendations, magnetic resonance imaging (MRI) is frequently used to follow these women. We sought to examine the findings on MRI studies done in this setting. METHODS This is a retrospective cohort study including all consecutive MRI exams done after bilateral mastectomy and reconstruction between January 2010 and April 2018. Data collected included demographic information, family history, BRCA status, indication for bilateral mastectomy, type of reconstruction, findings on MRI, and work-up of MRI findings. Cancer detection rate and interval cancer rates were calculated. RESULTS One hundred fifty-nine women had 415 surveillance MRI exams. Most (372, 90%) studies were done in women with implant-based reconstruction. Four hundred and five (98%; 95% confidence interval (CI) 96-99%) of the studies were negative. One breast recurrence was found on MRI (cancer detection rate 2.4 per 1000 MRI exams, 95% CI 0.4-13); however, this woman was simultaneously diagnosed with metastatic disease. The false-positive rate was 90% (95% CI 54-99%). During follow-up three women were diagnosed with local recurrence (interval cancer rate 5 per 1000, 95% CI 1.3-17) and 4 women were diagnosed with metastatic disease. CONCLUSION The yield of surveillance MRI in women with bilateral mastectomy and reconstruction is very low. As most of the cohort had retro-pectoral implant-based reconstruction, it appears safe to recommend against surveillance MRI in this setting regardless of the indication for mastectomy.
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Affiliation(s)
- Orit Golan
- Department of Breast Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Amitai
- Department of Breast Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, Toronto, ON, Canada
| | - Yoav Barnea
- Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah S Menes
- Department of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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18
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Laitman Y, Michaelson-Cohen R, Levi E, Chen-Shtoyerman R, Reish O, Josefsberg Ben-Yehoshua S, Bernstein-Molho R, Keinan-Boker L, Rosengarten O, Silverman BG, Perri T, Korach J, Mor P, Ephrat Ben-Baruch N, Levy Lahad E, Friedman E. Uterine cancer in Jewish Israeli BRCA1/2 mutation carriers. Cancer 2018; 125:698-703. [PMID: 30489631 DOI: 10.1002/cncr.31842] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND BRCA1/2 mutation carriers have an increased risk of developing ovarian cancer, leading to the recommendation of risk-reducing salpingo-oophorectomy (RRSO) at 35-40 years of age. The role, if any, that BRCA mutations play in conferring uterine cancer risk, is unresolved. METHOD Jewish Israeli women, carriers of one of the predominant Jewish mutations in BRCA1/2 from 1998 to 2016, were recruited. Cancer diagnoses were determined through the Israeli National Cancer Registry. Uterine cancer risk was assessed by computing the standardized incidence ratio of observed-to-expected number of cases, using the exact 2-sided P value of Poisson count. RESULTS Overall, 2627 eligible mutation carriers were recruited from 1998 to 2016, 2312 (88%) of whom were Ashkenazi Jews (1463 BRCA1, 1154 BRCA2 mutation carriers, 10 double mutation carriers). Among these participants, 1310 underwent RRSO without hysterectomy at a mean (± standard deviation) age of 43.6 years (± 4.4 years). During 32,774 women-years of follow up, 14 women developed uterine cancer, and the observed-to-expected rate of all histological subtypes was 3.98 (95% confidence interval [CI], 2.17-6.67; P < .001). For serous papillary (n = 5), the observed-to-expected ratio was 14.29 (95% CI, 4.64-33.34; P < .001), and for sarcoma (n = 4) it was 37.74 (95% CI, 10.28-96.62). These rates were also higher than those detected in a group of 1844 age- and ethnicity-matched women (53% with breast cancer). CONCLUSION Israeli BRCA1 or BRCA2 mutation carriers are at an increased risk for developing uterine cancer, especially serous papillary and sarcoma. These elevated risks of uterine cancer should be discussed with BRCA carriers.
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Affiliation(s)
- Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Michaelson-Cohen
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Einat Levi
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rakefet Chen-Shtoyerman
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Orit Reish
- Genetics Institute, Assaf Harofe Medical Center, Zerifin, Israel
| | - Sagi Josefsberg Ben-Yehoshua
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rinat Bernstein-Molho
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Ora Rosengarten
- Gyneco-Oncology Unit, Institute of Oncology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Barbara G Silverman
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Tamar Perri
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Korach
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pnina Mor
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Noa Ephrat Ben-Baruch
- Oncology Department, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Ephrat Levy Lahad
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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19
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Laitman Y, Feldman DM, Sklair-Levy M, Yosepovich A, Barshack-Nakar I, Brodsky M, Halshtok O, Shalmon A, Gotlieb M, Friedman E. Abnormal Findings Detected by Multi-modality Breast Imaging and Biopsy Results in a High-risk Clinic. Clin Breast Cancer 2018; 18:e695-e698. [PMID: 29292184 DOI: 10.1016/j.clbc.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND High-risk BRCA mutation carriers are offered a surveillance scheme aimed at early detection of breast cancer. Although the efficacy of this scheme in breast cancer detection is well-established, the rate of breast cancer diagnosis of radiologically suspicious lesions and the effect of this screening scheme on breast cancer grade and stage are less well-defined. PATIENTS AND METHODS Female BRCA1 and BRCA2 mutation carriers who were cancer-free at the beginning of follow-up at the Meirav High-risk Clinic, Sheba Medical Center, were eligible. Radiological imaging data (mammography, ultrasound, magnetic resonance imaging, Breast Imaging Reporting and Data System scores), and histopathologic data on breast biopsies were retrieved. RESULTS Overall, 1055 women participated in the study; 760 (72%) were Ashkenazim, 661 (62.6%) were BRCA1 mutation carriers, the mean age at first visit was 44.1 ± 11.8 years, and there was a mean follow-up of 6.2 years. All participants underwent 6641 breast imaging tests: 2613 magnetic resonance imagings, 2662 breast ultrasounds, and 1366 mammograms. Overall, 295 biopsies were performed on 254 women: 82 (27%) biopsies on 79 women were diagnosed with breast cancer, including ductal carcinoma in situ: invasive breast cancer was diagnosed in 58 (70.7%), of whom 36 (62% of invasive cancer) were grade 3, and all but 10 were stage 1 to 2. Benign findings were noted in 213 biopsies performed on 175 women, with fibrocystic disease (n = 134; 62.9%) or fibroadenoma (n = 60; 28.16%) most commonly diagnosed. CONCLUSIONS Adherence to a breast cancer surveillance scheme enables breast cancer detection at an early stage but at advanced grade. Most biopsies (72%) performed in this high-risk clinic are benign.
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Affiliation(s)
- Yael Laitman
- Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Miri Sklair-Levy
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ady Yosepovich
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Breast Pathology Service, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Barshack-Nakar
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malka Brodsky
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Osnat Halshtok
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Anat Shalmon
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Gotlieb
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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20
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Hegde JV, Wang X, Attai DJ, DiNome ML, Kusske A, Hoyt AC, Hurvitz SA, Weidhaas JB, Steinberg ML, McCloskey SA. Predictors associated with MRI surveillance screening in women with a personal history of unilateral breast cancer but without a genetic predisposition for future contralateral breast cancer. Breast Cancer Res Treat 2017; 166:145-156. [PMID: 28702891 DOI: 10.1007/s10549-017-4392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/07/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE For women with a personal history of breast cancer (PHBC), no validated mechanisms exist to calculate future contralateral breast cancer (CBC) risk. The Manchester risk stratification guidelines were developed to evaluate CBC risk in women with a PHBC, primarily for surgical decision making. This tool may be informative for the use of MRI screening, as CBC risk is an assumed consideration for high-risk surveillance. METHODS Three hundred twenty-two women with a PHBC were treated with unilateral surgery within our multidisciplinary breast clinic. We calculated lifetime CBC risk using the Manchester tool, which incorporates age at diagnosis, family history, genetic mutation status, estrogen receptor positivity, and endocrine therapy use. Univariate and multivariate logistic regression analyses (UVA/MVA) were performed, evaluating whether CBC risk predicted MRI surveillance. RESULTS For women with invasive disease undergoing MRI surveillance, 66% had low, 23% above-average, and 11% moderate/high risk for CBC. On MVA, previous mammography-occult breast cancer [odds ratio (OR) 18.95, p < 0.0001], endocrine therapy use (OR 3.89, p = 0.009), dense breast tissue (OR 3.69, p = 0.0007), mastectomy versus lumpectomy (OR 3.12, p = 0.0041), and CBC risk (OR 3.17 for every 10% increase, p = 0.0002) were associated with MRI surveillance. No pathologic factors increasing ipsilateral breast cancer recurrence were significant on MVA. CONCLUSIONS Although CBC risk predicted MRI surveillance, 89% with invasive disease undergoing MRI had <20% calculated CBC risk. Concerns related to future breast cancer detectability (dense breasts and/or previous mammography-occult disease) predominate decision making. Pathologic factors important for determining ipsilateral recurrence risk, aside from age, were not associated with MRI surveillance.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, University of California, Los Angeles, 1223 16th Street, Suite 1100, Santa Monica, CA, 90404, USA
| | - Xiaoyan Wang
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Deanna J Attai
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maggie L DiNome
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy Kusske
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne C Hoyt
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sara A Hurvitz
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California, Los Angeles, 1223 16th Street, Suite 1100, Santa Monica, CA, 90404, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, 1223 16th Street, Suite 1100, Santa Monica, CA, 90404, USA
| | - Susan A McCloskey
- Department of Radiation Oncology, University of California, Los Angeles, 1223 16th Street, Suite 1100, Santa Monica, CA, 90404, USA.
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21
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Kim YC, Soliman AS, Cui J, Ramadan M, Hablas A, Abouelhoda M, Hussien N, Ahmed O, Zekri ARN, Seifeldin IA, Wang SM. Unique Features of Germline Variation in Five Egyptian Familial Breast Cancer Families Revealed by Exome Sequencing. PLoS One 2017; 12:e0167581. [PMID: 28076423 PMCID: PMC5226826 DOI: 10.1371/journal.pone.0167581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/16/2016] [Indexed: 12/31/2022] Open
Abstract
Genetic predisposition increases the risk of familial breast cancer. Recent studies indicate that genetic predisposition for familial breast cancer can be ethnic-specific. However, current knowledge of genetic predisposition for the disease is predominantly derived from Western populations. Using this existing information as the sole reference to judge the predisposition in non-Western populations is not adequate and can potentially lead to misdiagnosis. Efforts are required to collect genetic predisposition from non-Western populations. The Egyptian population has high genetic variations in reflecting its divergent ethnic origins, and incident rate of familial breast cancer in Egypt is also higher than the rate in many other populations. Using whole exome sequencing, we investigated genetic predisposition in five Egyptian familial breast cancer families. No pathogenic variants in BRCA1, BRCA2 and other classical breast cancer-predisposition genes were present in these five families. Comparison of the genetic variants with those in Caucasian familial breast cancer showed that variants in the Egyptian families were more variable and heterogeneous than the variants in Caucasian families. Multiple damaging variants in genes of different functional categories were identified either in a single family or shared between families. Our study demonstrates that genetic predisposition in Egyptian breast cancer families may differ from those in other disease populations, and supports a comprehensive screening of local disease families to determine the genetic predisposition in Egyptian familial breast cancer.
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Affiliation(s)
- Yeong C. Kim
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Amr S. Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail: (ASS); (SMW)
| | - Jian Cui
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Mohamed Ramadan
- Gharbiah Cancer Society, Gharbiah Population-based Registry, Tanta, Egypt
| | - Ahmed Hablas
- Gharbiah Cancer Society, Gharbiah Population-based Registry, Tanta, Egypt
| | | | - Nehal Hussien
- Egypt National Cancer Institute, Cairo University, Giza, Egypt
| | - Ola Ahmed
- Egypt National Cancer Institute, Cairo University, Giza, Egypt
| | | | | | - San Ming Wang
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail: (ASS); (SMW)
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