期刊
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
卷 21, 期 9, 页码 1458-1468出版社
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-11-1196
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资金
- Bayer Pharmaceuticals
- Sentinelle Medical
- Vista diagnostics
- Specialty Scanners
- UK Technology Strategy Board
- Philips
- Siemens
- General Electric
- The Dutch government (ZONMW) [6200.0005]
- Cancer Genomics Center (CGC), the Netherlands (MRISC study)
- The Canadian Breast Cancer Research Alliance
- The Terry Fox Foundation
- International Breast MRI Consortium
- the (Canadian) National Breast Cancer Fund
- Papoff Family
- The Medical Research Council [G9600413]
- Cancer Research UK [C5047/A3354]
- NIHR
- Royal Marsden NHS Foundation Trust
- Central Manchester Foundation Trust (MARIBS study)
- Cancer Research UK [15007] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0510-10096] Funding Source: researchfish
Background: It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines. Methods: Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality. Results: BRCA1/2 mutation carriers (N = 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or <= 10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening. Conclusions: Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history. Impact: BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40. Cancer Epidemiol Biomarkers Prev; 21(9); 1458-68. (C) 2012 AACR.
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