For young women with high genetic risk for breast cancer, intensive surveillance and examination by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) every six months is more effective for timely detection of early breast cancer lesions than annual mammogram, a new study finds.
“This study demonstrates, for the first time, that aggressive breast cancers can be caught early, without excessive recalls or biopsies,” Olufunmilayo Olopade, MD, professor of medicine and human genetics and director of the University of Chicago’s Center for Clinical Cancer Genetics, said in a press release. “Because of intensive surveillance and high quality care the majority of high-risk women in this study — most of whom had highly penetrant genetic mutations — have not developed breast cancer.”
The findings were recently presented during the annual San Antonio Breast Cancer Symposium, in the poster, “Breast cancer surveillance in high-risk women with dynamic contrast-enhanced magnetic resonance imaging every 6 months: Results from a single institution study.”
The American Cancer Society recommends that high-risk women – those with a family history of breast cancer and BRCA mutations – undergo annual DCE-MRI plus annual mammograms.
However, the researchers from Chicago and Washington aimed to assess if offering a DCE-MRI examination every six months and an annual mammogram could improve the outcomes of these women.
Between 2004 and December 2016, they recruited 295 patients into a clinical trial. These women had a lifetime breast cancer risk greater than 20 percent and/or had mutation in one of 11 known breast cancer genes, including BRCA1 or BRCA2.
Patients were evaluated by a clinician and a genetic counselor, and if they met the criteria for high-risk, they were scheduled to undergo a DCE-MRI scan every six months and an annual mammography.
After an average of seven DCE-MRIs and four mammograms per patient, the screening identified 17 cancer cases – four ductal carcinoma in situ and 13 early stage breast cancers. In all cases, the tumor was smaller than 1 centimeter and had not spread to the lymph nodes.
The majority of patients who developed tumors (15) carried a disease-causing mutation: 11 had mutations in the BRCA1 gene, three in the BRCA2, and one in the CDH1 gene.
The 17 cases of breast cancer were followed continuously throughout a median of 5.3 years. Patients are alive and disease failed to spread to other body parts.
DCE-MRI every six months “performed well for early detection of invasive breast cancer in high-risk women, accomplishing the ultimate goal of breast cancer screening — detecting node-negative, invasive tumors less than 1 centimeter,” said Olopade, an American Cancer Society Clinical Research professor and study lead author. “These scans performed especially well in BRCA1 mutation carriers, who are at risk for aggressive subtypes of breast cancer.”
“Mammograms remain important for most women,” Olopade added. “But for women at high risk who are getting a DCE-MRI every six months, annual mammograms could probably be eliminated. For this group of younger women at significantly elevated risk, especially those with a BRCA1 mutation, we strongly support getting a DCE-MRI every six months.”
Study co-author Mary Claire King, PhD, believes that every woman should undergo testing for mutations in the BRCA1 and BRCA2 by the age of 30, independent of their personal or family history of cancer.
“My concern is that mammography and MRI be used in ways that make sense given a woman’s personal genetics,” said King, a professor of genome sciences and of medicine at the University of Washington and the Walt Disney-American Cancer Society Research Professor for Breast Cancer. “Women with mutations in BRCA1 or BRCA2 have very different needs for surveillance for breast disease than do women with no mutations in these genes. This is particularly true for healthy young women with mutations. It’s truly critical to offer intensive surveillance to still-healthy women with BRCA1 or BRCA2 mutations.”
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