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Should we screen BRCA1 mutation carriers only with MRI? A multicenter study

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Abstract

BRCA1 mutation carriers are offered screening with MRI and mammography. Aim of the study was to investigate the additional value of digital mammography over MRI screening. BRCA1 mutation carriers, who developed breast cancer since the introduction of digital mammography between January 2003 and March 2013, were included. The images and reports were reviewed in order to assess whether the breast cancers were screen-detected or interval cancers and whether they were visible on mammography and MRI, using the breast imaging and data system classification allocated at the time of diagnosis. In 93 BRCA1 mutation carriers who underwent screening with MRI and mammography, 82 invasive breast cancers and 12 ductal carcinomas in situ (DCIS) were found. Screening sensitivity was 95.7 % (90/94). MRI detected 88 of 94 breast cancers (sensitivity 93.6 %), and mammography detected 48 breast cancers (sensitivity 51.1 %) (two-sided p < 0.001). Forty-two malignancies were detected only by MRI (42/94 = 44.7 %). Two DCIS were detected only with mammography (2/94 = 2.1 %) concerning a grade 3 in a 50-year-old patient and a grade 2 in a 67-year-old patient. Four interval cancers occurred (4/94 = 4.3 %), all grade 3 triple negative invasive ductal carcinomas. In conclusion, digital mammography added only 2 % to the breast cancer detection in BRCA1 patients. There was no benefit of additional mammography in women below age 40. Given the potential risk of radiation-induced breast cancer in young mutation carriers, we propose to screen BRCA1 mutation carriers yearly with MRI from age 25 onwards and to start with mammographic screening not earlier than age 40.

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Acknowledgments

The authors thank Eveline Heijnsdijk and Sepideh Saadatmand for their efforts.

Conflict of interest

The authors declared no possible conflicts of interest.

Disclosure

One of the authors (R.M) receives honoraria from Bayer Healthcare for lecturing.

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Authors and Affiliations

  1. Department of Radiology, Erasmus University Medical Center Rotterdam, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands

    Inge-Marie Obdeijn & M. G. Myriam Hunink

  2. Department of Radiology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands

    Gonneke A. O. Winter-Warnars

  3. Department of Radiology, University Medical Center Nijmegen, Geert Grooteplein-Zuid 1, 6525, GA, Nijmegen, The Netherlands

    Ritse M. Mann

  4. Department of Medical Oncology, Erasmus University Medical Center, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands

    Maartje J. Hooning

  5. Department of Epidemiology, Erasmus University Medical Center, ‘s, Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands

    M. G. Myriam Hunink

  6. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    M. G. Myriam Hunink

  7. Department of Surgery, Erasmus University Medical Center, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands

    Madeleine M. A. Tilanus-Linthorst

Authors
  1. Inge-Marie Obdeijn
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  2. Gonneke A. O. Winter-Warnars
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  3. Ritse M. Mann
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  4. Maartje J. Hooning
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  5. M. G. Myriam Hunink
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  6. Madeleine M. A. Tilanus-Linthorst
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Correspondence to Inge-Marie Obdeijn.

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Obdeijn, IM., Winter-Warnars, G.A.O., Mann, R.M. et al. Should we screen BRCA1 mutation carriers only with MRI? A multicenter study. Breast Cancer Res Treat 144, 577–582 (2014). https://doi.org/10.1007/s10549-014-2888-8

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  • DOI: https://doi.org/10.1007/s10549-014-2888-8

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