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Breast Cancer Research and Treatment

, Volume 144, Issue 3, pp 577–582 | Cite as

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

  • Inge-Marie Obdeijn
  • Gonneke A. O. Winter-Warnars
  • Ritse M. Mann
  • Maartje J. Hooning
  • M. G. Myriam Hunink
  • Madeleine M. A. Tilanus-Linthorst
Clinical trial

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.

Keywords

BRCA1 mutation carriers Breast cancer Screening Digital mammography MRI Radiation-induced breast cancer 

Notes

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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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Inge-Marie Obdeijn
    • 1
  • Gonneke A. O. Winter-Warnars
    • 2
  • Ritse M. Mann
    • 3
  • Maartje J. Hooning
    • 4
  • M. G. Myriam Hunink
    • 1
    • 5
    • 6
  • Madeleine M. A. Tilanus-Linthorst
    • 7
  1. 1.Department of RadiologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Department of RadiologyAntoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of RadiologyUniversity Medical Center NijmegenNijmegenThe Netherlands
  4. 4.Department of Medical OncologyErasmus University Medical CenterRotterdamThe Netherlands
  5. 5.Department of EpidemiologyErasmus University Medical Center, ‘sRotterdamThe Netherlands
  6. 6.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  7. 7.Department of SurgeryErasmus University Medical CenterRotterdamThe Netherlands

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