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Risk-Based Screening Mammography for Women Aged <40: Outcomes From the National Mammography Database. J Am Coll Radiol 2019; 17:368-376. [PMID: 31541655 DOI: 10.1016/j.jacr.2019.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/16/2019] [Accepted: 08/25/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There is insufficient large-scale evidence for screening mammography in women <40 years at elevated risk. This study compares risk-based screening of women aged 30 to 39 with risk factors versus women aged 40 to 49 without risk factors in the National Mammography Database (NMD). METHODS This retrospective, HIPAA-compliant, institutional review board-exempt study analyzed data from 150 NMD mammography facilities in 31 states. Patients were stratified by 5-year age intervals, availability of prior mammograms, and specific risk factors for breast cancer: family history of breast cancer, personal history of breast cancer, and dense breasts. Four screening performance metrics were calculated for each age and risk group: recall rate (RR), cancer detection rate (CDR), and positive predictive values for biopsy recommended (PPV2) and biopsy performed (PPV3). RESULTS Data from 5,986,131 screening mammograms performed between January 2008 and December 2015 in 2,647,315 women were evaluated. Overall, mean CDR was 3.69 of 1,000 (95% confidence interval: 3.64-3.74), RR was 9.89% (9.87%-9.92%), PPV2 was 20.1% (19.9%-20.4%), and PPV3 was 28.2% (27.0%-28.5%). Women aged 30 to 34 and 35 to 39 had similar CDR, RR, and PPVs, with the presence of the three evaluated risk factors associated with significantly higher CDR. Moreover, compared with a population currently recommended for screening mammography in the United States (aged 40-49 at average risk), incidence screening (at least one prior screening examination) of women aged 30 to 39 with the three evaluated risk factors has similar cancer detection rates and recall rates. DISCUSSION Women with one or more of these three specific risk factors likely benefit from screening commencing at age 30 instead of age 40.
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Lancaster RB, Gulla S, De Los Santos J, Umphrey H. Breast Cancer Screening and Optimizing Recommendations. Semin Roentgenol 2018; 53:280-293. [DOI: 10.1053/j.ro.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Podo F, Santoro F, Di Leo G, Manoukian S, de Giacomi C, Corcione S, Cortesi L, Carbonaro LA, Trimboli RM, Cilotti A, Preda L, Bonanni B, Pensabene M, Martincich L, Savarese A, Contegiacomo A, Sardanelli F. Triple-Negative versus Non-Triple-Negative Breast Cancers in High-Risk Women: Phenotype Features and Survival from the HIBCRIT-1 MRI-Including Screening Study. Clin Cancer Res 2015; 22:895-904. [PMID: 26503945 DOI: 10.1158/1078-0432.ccr-15-0459] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/28/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare phenotype features and survival of triple-negative breast cancers (TNBC) versus non-TNBCs detected during a multimodal annual screening of high-risk women. EXPERIMENTAL DESIGN Analysis of data from asymptomatic high-risk women diagnosed with invasive breast cancer during the HIBCRIT-1 study with median 9.7-year follow-up. RESULTS Of 501 enrolled women with BRCA1/2 mutation or strong family history (SFH), 44 were diagnosed with invasive breast cancers: 20 BRCA1 (45%), 9 BRCA2 (21%), 15 SFH (34%). Magnetic resonance imaging (MRI) sensitivity (90%) outperformed that of mammography (43%, P < 0.001) and ultrasonography (61%, P = 0.004). The 44 cases (41 screen-detected; 3 BRCA1-associated interval TNBCs) comprised 14 TNBCs (32%) and 30 non-TNBCs (68%), without significant differences for age at diagnosis, menopausal status, prophylactic oophorectomy, or previous breast cancer. Of 14 TNBC patients, 11 (79%) were BRCA1; of the 20 BRCA1 patients, 11 (55%) had TNBC; and of 15 SFH patients, 14 (93%) had non-TNBCs (P = 0.007). Invasive ductal carcinomas (IDC) were 86% for TNBCs versus 43% for non-TNBCs (P = 0.010), G3 IDCs 71% versus 23% (P = 0.006), size 16 ± 5 mm versus 12 ± 6 mm (P = 0.007). TNBC patients had more frequent ipsilateral mastectomy (79% vs. 43% for non-TNBCs, P = 0.050), contralateral prophylactic mastectomy (43% vs. 10%, P = 0.019), and adjuvant chemotherapy (100% vs. 44%, P < 0.001). The 5-year overall survival was 86% ± 9% for TNBCs versus 93% ± 5% (P = 0.946) for non-TNBCs; 5-year disease-free survival was 77% ± 12% versus 76% ± 8% (P = 0.216). CONCLUSIONS In high-risk women, by combining an MRI-including annual screening with adequate treatment, the usual reported gap in outcome between TNBCs and non-TNBCs could be reduced.
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Affiliation(s)
- Franca Podo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy.
| | - Filippo Santoro
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Clelia de Giacomi
- Department of Medical Oncology, CRO-Centro di Riferimento Oncologico, Aviano (PN), Italy
| | - Stefano Corcione
- Breast Imaging Unit, Sant'Anna Universitary Hospital, Cona (FE), Italy
| | - Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliera Policlinico, Modena, Italy
| | | | | | - Anna Cilotti
- Radiological Section, Ospedale Santa Chiara, University of Pisa, Pisa, Italy
| | - Lorenzo Preda
- Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Matilde Pensabene
- Department of Clinical Medicine and Surgery, Clinical Unit of "Hereditary and Familial Cancers", University Hospital Federico II, Naples, Italy
| | - Laura Martincich
- Unit of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | | | - Alma Contegiacomo
- Department of Clinical Medicine and Surgery, Clinical Unit of "Hereditary and Familial Cancers", University Hospital Federico II, Naples, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Efficacy of Sonazoid (Perflubutane) for Contrast-Enhanced Ultrasound in the Differentiation of Focal Breast Lesions: Phase 3 Multicenter Clinical Trial. AJR Am J Roentgenol 2014; 202:W400-7. [DOI: 10.2214/ajr.12.10518] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Palomba G, Budroni M, Olmeo N, Atzori F, Ionta MT, Pisano M, Tanda F, Cossu A, Palmieri G. Triple-negative breast cancer frequency and type of BRCA mutation: Clues from Sardinia. Oncol Lett 2014; 7:948-952. [PMID: 24944648 PMCID: PMC3961447 DOI: 10.3892/ol.2014.1834] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/19/2013] [Indexed: 11/27/2022] Open
Abstract
Germline mutations in BRCA1 or BRCA2 genes have been demonstrated to increase the risk of developing breast cancer. Among the prognostic factors currently used in clinical practice, the disease stage and the receptor status play a crucial role in the management of breast carcinoma. Triple-negative breast cancer (TNBC) has been classified as a disease subgroup that is negative for oestrogen, progesterone and HER2 receptor expression, and presents a poor prognosis. The present study investigated the correlation between BRCA1/2 mutations and TNBC status in a large series (n=726) of breast cancer patients from Sardinia. The BRCA mutation screening was performed on genomic DNA from peripheral blood samples by denaturing high-performance liquid chromatography analysis and automated DNA sequencing. Overall, 21/726 (2.9%) patients carried a germline mutation in BRCA1 or BRCA2. The TNBC phenotype was significantly associated with the BRCA1 mutations (P<0.001), whereas no association was found with the BRCA2 mutations (P=0.837). With respect to patient origin within Sardinia, a significant inverse distribution of mutations was found; BRCA1 and BRCA2 mutations represented 86 and 93% of the mutated cases in Southern and Middle-Northern Sardinia, respectively (P<0.001). Patients from the geographical area with BRCA1 mutation prevalence presented a TNBC incidence much higher than that observed in cases from the area with BRCA2 mutation prevalence (12 vs. 4%, respectively; P=0.037). These findings further confirmed that the occurrence of TNBC is significantly associated with the BRCA1 mutation carrier status and that a different ‘genetic background’ may have a phenotypic impact in the onset of breast cancer.
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Affiliation(s)
- Grazia Palomba
- Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Sassari, Italy
| | - Mario Budroni
- Service of Epidemiology, Local Health Unit 1 (ASL1), Sassari, Sassari, Italy
| | - Nina Olmeo
- Unit of Medical Oncology, Local Health Unit 1 (ASL1), Sassari, Sassari, Italy
| | - Francesco Atzori
- Department of Medical Oncology, Hospital-University Health Unit (AOU), Cagliari, Cagliari, Italy
| | - Maria Teresa Ionta
- Department of Medical Oncology, Hospital-University Health Unit (AOU), Cagliari, Cagliari, Italy
| | - Marina Pisano
- Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Sassari, Italy
| | - Francesco Tanda
- Institute of Pathology, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Service of Pathology, Hospital-University Health Unit (AOU), Sassari, Sassari, Italy
| | - Giuseppe Palmieri
- Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Sassari, Italy
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Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
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Supplemental screening ultrasound increases cancer detection yield in BRCA1 and BRCA2 mutation carriers. Arch Gynecol Obstet 2013; 289:663-70. [PMID: 24045978 DOI: 10.1007/s00404-013-3022-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study aimed at evaluating the efficacy of ultrasound for the early detection of breast cancers in BRCA1/2 mutation carriers. METHODS Between 01/1997 and 10/2008 221 BRCA1/2 mutation carriers participated in a breast cancer screening program which included semi-annual ultrasound in combination with annual mammography and magnetic resonance imaging (MRI). Women underwent on average (median) five semi-annual screening rounds with a range of one to 22 appointments, totaling 1,855 rounds of screening. All three imaging modalities were coded according to the American College of Radiology (BI-RADS classification). RESULTS In total, we detected 27 BRCA-associated breast cancers in 25 patients. The sensitivity was 77% for ultrasound, 27% for mammography, and 100% for MRI. Three tumors were detected directly as a result of only the semi-annual ultrasound screen. CONCLUSIONS Due to the specific tumor morphology and the considerably elevated tumor doubling time, mutation carriers benefit from the addition of semi-annual ultrasound screening as a sensitive and cost-effective method.
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Duncan PR, Lin JT. Ingredients for success: a familial cancer clinic in an oncology practice setting. J Oncol Pract 2013; 7:39-42. [PMID: 21532809 DOI: 10.1200/jop.2010.000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Genetic cancer risk assessment (GCRA) has become increasingly important in clinical cancer care. Almost all published information on genetic risk assessment has come from academic institutions. However, a majority of patients with cancer are seen in the community practice setting. METHODS We describe the evolution of a community oncology practice GCRA clinic. RESULTS Over a 10-year period, 445 patients were seen for a possible genetic cancer syndrome. This included 325 patients with family history of breast or ovarian cancer, 92 patients with family history of colorectal cancer or polyposis, and 28 families with another familial cancer predisposition. Fifty-three unique families with a genetic mutation were identified. CONCLUSION A GCRA clinic can be incorporated into an oncology practice setting and can enhance the standard of care for the entire community. We present data reflecting a 10-year experience with such a clinic and provide recommendations for establishing a successful one.
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Affiliation(s)
- Paul R Duncan
- Hematology Oncology Associates, PC; Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM
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Zhao X, Mirza S, Alshareeda A, Zhang Y, Gurumurthy CB, Bele A, Kim JH, Mohibi S, Goswami M, Lele SM, West W, Qiu F, Ellis IO, Rakha EA, Green AR, Band H, Band V. Overexpression of a novel cell cycle regulator ecdysoneless in breast cancer: a marker of poor prognosis in HER2/neu-overexpressing breast cancer patients. Breast Cancer Res Treat 2012; 134:171-80. [PMID: 22270930 PMCID: PMC3397230 DOI: 10.1007/s10549-011-1946-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/26/2011] [Indexed: 01/16/2023]
Abstract
Uncontrolled proliferation is one of the hallmarks of breast cancer. We have previously identified the human Ecd protein (human ortholog of Drosophila Ecdysoneless, hereafter called Ecd) as a novel promoter of mammalian cell cycle progression, a function related to its ability to remove the repressive effects of Rb-family tumor suppressors on E2F transcription factors. Given the frequent dysregulation of cell cycle regulatory components in human cancer, we used immunohistochemistry of paraffin-embedded tissues to examine Ecd expression in normal breast tissue versus tissues representing increasing breast cancer progression. Initial studies of a smaller cohort without outcomes information showed that Ecd expression was barely detectable in normal breast tissue and in hyperplasia of breast, but high levels of Ecd were detected in benign breast hyperplasia, ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDCs) of the breast. In this cohort of 104 IDC patients, Ecd expression levels showed a positive correlation with higher grade (P = 0.04). Further analyses of Ecd expression using a larger, independent cohort (954) confirmed these results, with a strong positive correlation of elevated Ecd expression with higher histological grade (P = 0.013), mitotic index (P = 0.032), and Nottingham Prognostic Index score (P = 0.014). Ecd expression was positively associated with HER2/neu (P = 0.002) overexpression, a known marker of poor prognosis in breast cancer. Significantly, increased Ecd expression showed a strong positive association with shorter breast cancer specific survival (BCSS) (P = 0.008) and disease-free survival (DFS) (P = 0.003) in HER2/neu overexpressing patients. Taken together, our results reveal Ecd as a novel marker for breast cancer progression and show that levels of Ecd expression predict poorer survival in Her2/neu overexpressing breast cancer patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibody Specificity
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast/metabolism
- Breast/pathology
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carrier Proteins/genetics
- Carrier Proteins/immunology
- Carrier Proteins/metabolism
- Cohort Studies
- Disease-Free Survival
- Female
- Gene Expression
- Humans
- Hyperplasia/metabolism
- Kaplan-Meier Estimate
- Middle Aged
- Prognosis
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Young Adult
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Affiliation(s)
- Xiangshan Zhao
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Sameer Mirza
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Alaa Alshareeda
- School of Molecular Medical Sciences and Cellular Pathology, University of Nottingham and Nottingham University Hospital, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Ying Zhang
- Abbott Molecular, 1300 E. Touhy Avenue, Des Plaines, IL 60018 USA
| | | | - Aditya Bele
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Jun Hyun Kim
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Shakur Mohibi
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Monica Goswami
- Department of Pathology and Laboratory Medicine, Tulane University Health Sciences, 1430 Tulane Avenue, SL79, New Orleans, LA 70112 USA
| | - Subodh M. Lele
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-3135 USA
| | - William West
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-3135 USA
| | - Fang Qiu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Ian O. Ellis
- School of Molecular Medical Sciences and Cellular Pathology, University of Nottingham and Nottingham University Hospital, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Emad A. Rakha
- School of Molecular Medical Sciences and Cellular Pathology, University of Nottingham and Nottingham University Hospital, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Andrew R. Green
- School of Molecular Medical Sciences and Cellular Pathology, University of Nottingham and Nottingham University Hospital, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Hamid Band
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-3135 USA
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
| | - Vimla Band
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-5805 USA
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Ileal metastasis of breast cancer in a patient with a BRCA2 gene mutation: report of a case. Surg Today 2011; 41:1665-9. [PMID: 21969203 DOI: 10.1007/s00595-011-4503-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/20/2011] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common malignancy in females. Common sites of metastases include the liver, lung, bone, and brain, while metastases to the extrahepatic digestive system are very rare. This report presents a patient diagnosed with breast carcinoma metastasis in the terminal ileum. The patient underwent breast-conserving surgery on both breasts because of breast cancer at the age of 46 years. Both breast cancers were consistent with stage I invasive ductal carcinomas. Colonoscopy during an investigation for hematochezia revealed a 2-cm ulceration in the terminal ileum 22 months later, and microscopic examination of a biopsy specimen of the ulceration revealed a poorly differentiated mass that was strongly suggestive of metastatic adenocarcinoma with endolymphatic tumor emboli. She underwent hand-assisted laparoscopic ileocecectomy because of ileal metastasis. She had a family history of breast cancer (sister) and colon cancer (brother). She exhibited HER2/neu discordance and carried the BRCA2 gene mutation. Surgeons should remain aware that breast cancer can metastasize to the gastrointestinal tract.
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Meyerson AF, Lessing JN, Itakura K, Hylton NM, Wolverton DE, Joe BN, Esserman LJ, Hwang ES. Outcome of long term active surveillance for estrogen receptor-positive ductal carcinoma in situ. Breast 2011; 20:529-33. [PMID: 21843942 DOI: 10.1016/j.breast.2011.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 05/20/2011] [Accepted: 06/03/2011] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION An option for active surveillance is not currently offered to patients with ductal carcinoma in situ (DCIS); however a small number of women decline standard surgical treatment for noninvasive cancer. The purpose of this study was to assess outcomes in a cohort of 14 well-informed women who elected non-surgical active surveillance with endocrine treatment alone for estrogen receptor-positive DCIS. METHODS Retrospective review of 14 women, 12 of whom were enrolled in an IRB-approved single-arm study of 3 months of neoadjuvant endocrine therapy prior to definitive surgical management. The patients in this report withdrew from the parent study opting instead for active surveillance with endocrine treatment and imaging. RESULTS 8 women had surgery at a median follow up of 28.3 months (range 10.1-70 months), 5 had stage I IDC at surgical excision, and 3 had DCIS alone. 6 women remain on surveillance without evidence of invasive disease for a median of 31.8 months (range 11.8-80.8 months). CONCLUSION Long-term active surveillance for DCIS is feasible in a well-informed patient population, but is associated with risk of invasive cancer at surgical excision.
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Affiliation(s)
- Anna F Meyerson
- University of California, San Francisco, Department of Radiology, 1600 Divisadero Street, Ste C-250, San Francisco, CA 94115, USA
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Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 2011; 46:94-105. [PMID: 21139507 DOI: 10.1097/rli.0b013e3181f3fcdf] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES : To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. MATERIALS AND METHODS : We enrolled asymptomatic women aged ≥ 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. RESULTS : A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥ 50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥ 50 years of age. CONCLUSION : MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.
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Teller P, Kramer RK. Management of the asymptomatic BRCA mutation carrier. APPLICATION OF CLINICAL GENETICS 2010; 3:121-31. [PMID: 23776357 PMCID: PMC3681169 DOI: 10.2147/tacg.s8882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current management of an asymptomatic BRCA mutation carrier includes early initiation and intensive cancer screening in combination with risk reduction strategies. The primary objectives of these interventions are earlier detection and cancer prevention to increase quality of life and prolonged survival. Existing recommendations are often based on the consensus of experts as there are few, supportive, randomized control trials. Management strategies for unaffected patients with BRCA mutations are continually redefined and customized as more evidence-based knowledge is acquired with regard to current intervention efficacy, mutation-related histology, and new treatment modalities. This review provides an outline of current, supported management principles, and interventions in the care of the asymptomatic BRCA mutation carrier. Topics covered include surveillance modalities and risk reduction achieved through behavioral modification, chemoprevention, and prophylactic surgery.
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Affiliation(s)
- Paige Teller
- Surgical Oncology, Medical University of South Carolina, Charleston, SC, USA
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Budroni M, Cesaraccio R, Coviello V, Sechi O, Pirino D, Cossu A, Tanda F, Pisano M, Palomba G, Palmieri G. Role of BRCA2 mutation status on overall survival among breast cancer patients from Sardinia. BMC Cancer 2009; 9:62. [PMID: 19232099 PMCID: PMC2653541 DOI: 10.1186/1471-2407-9-62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 02/20/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Germline mutations in BRCA1 or BRCA2 genes have been demonstrated to increase the risk of developing breast cancer. Conversely, the impact of BRCA mutations on prognosis and survival of breast cancer patients is still debated. In this study, we investigated the role of such mutations on breast cancer-specific survival among patients from North Sardinia. METHODS Among incident cases during the period 1997-2002, a total of 512 breast cancer patients gave their consent to undergo BRCA mutation screening by DHPLC analysis and automated DNA sequencing. The Hakulinen, Kaplan-Meier, and Cox regression methods were used for both relative survival assessment and statistical analysis. RESULTS In our series, patients carrying a germline mutation in coding regions and splice boundaries of BRCA1 and BRCA2 genes were 48/512 (9%). Effect on overall survival was evaluated taking into consideration BRCA2 carriers, who represented the vast majority (44/48; 92%) of mutation-positive patients. A lower breast cancer-specific overall survival rate was observed in BRCA2 mutation carriers after the first two years from diagnosis. However, survival rates were similar in both groups after five years from diagnosis. No significant difference was found for age of onset, disease stage, and primary tumour histopathology between the two subsets. CONCLUSION In Sardinian breast cancer population, BRCA2 was the most affected gene and the effects of BRCA2 germline mutations on patients' survival were demonstrated to vary within the first two years from diagnosis. After a longer follow-up observation, breast cancer-specific rates of death were instead similar for BRCA2 mutation carriers and non-carriers.
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Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted with Digital Mammography. AJR Am J Roentgenol 2008; 191:W275-82. [DOI: 10.2214/ajr.07.3588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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