Long-term results of screening with magnetic resonance imaging in women with BRCA mutations
British Journal of Cancer, 05/17/2012
Passaperuma K et al. – Magnetic resonance imaging surveillance of women with BRCA1/2 mutations will detect the majority of breast cancers at a very early stage. The absence of distant recurrences of incident cancers to date is encouraging. However, longer follow-up is needed to confirm the safety of breast surveillance. Methods
- From 1997 to 2009, 496 women aged 25 to 65 years with a known BRCA1/2 mutation, of whom 380 had no previous cancer history, were enrolled in a prospective screening trial that included annual MRI and mammography.
- In 1847 screening rounds, 57 cancers were identified (53 screen-detected, 1 interval, and 3 incidental at prophylactic mastectomy), of which 37 (65%) were invasive.
- Sensitivity of MRI vs mammography was 86% vs 19% over the entire study period (P<0.0001), but was 74% vs 35% from 1997 to 2002 (P=0.02) and 94% vs 9% from 2003 to 2009 (P<0.0001), respectively.
- The relative sensitivities of MRI and mammography did not differ by mutation, age, or invasive vs non-invasive disease.
- Of the incident cancers, 97% were Stage 0 or 1.
- Of 28 previously unaffected women diagnosed with invasive cancer, 1 BRCA1 mutation carrier died following relapse of a 3?cm, node-positive breast cancer diagnosed on her first screen at age 48 (annual breast cancer mortality rate=0.5%).
- Three patients died of other causes.
- None of the 24 survivors has had a distant recurrence at a median follow-up of 8.4 years since diagnosis.