Breast magnetic resonance image screening and ductal lavage in women at high genetic risk for breast carcinoma.
BACKGROUND
Intensive screening is an alternative to prophylactic mastectomy in women at high risk for developing breast carcinoma. The current article reports preliminary results from a screening protocol using high-quality magnetic resonance imaging (MRI), ductal lavage (DL), clinical breast examination, and mammography to identify early malignancy and high-risk lesions in women at increased genetic risk of breast carcinoma.


METHODS
Women with inherited BRCA1 or BRCA2 mutations or women with a >10% risk of developing breast carcinoma at 10 years, as estimated by the Claus model, were eligible. Patients were accrued from September 2001 to May 2003. Enrolled patients underwent biannual clinical breast examinations and annual mammography, breast MRI, and DL.


RESULTS
Forty-one women underwent an initial screen. Fifteen of 41 enrolled women (36.6%) either had undergone previous bilateral oophorectomy and/or were on tamoxifen at the time of the initial screen. One patient who was a BRCA1 carrier had high-grade ductal carcinoma in situ (DCIS) that was screen detected by MRI but that was missed on mammography. High-risk lesions that were screen detected by MRI in three women included radial scars and atypical lobular hyperplasia. DL detected seven women with cellular atypia, including one woman who had a normal MRI and mammogram.


CONCLUSIONS
Breast MRI identified high-grade DCIS and high-risk lesions that were missed by mammography. DL detected cytologic atypia in a high-risk cohort. A larger screening trial is needed to determine which subgroups of high-risk women will benefit and whether the identification of malignant and high-risk lesions at an early stage will impact breast carcinoma incidence and mortality.
Hartman
Anne-Renee
AR
Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5458, USA.
Daniel
Bruce L
BL
Kurian
Allison W
AW
Mills
Meredith A
MA
Nowels
Kent W
KW
Dirbas
Frederick M
FM
Kingham
Kerry E
KE
Chun
Nicki M
NM
Herfkens
Robert J
RJ
Ford
James M
JM
Plevritis
Sylvia K
SK
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D016504:Breast Self-Examination; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000235:genetics / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000235:genetics*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D042361:Mammary Glands, Human / Q000473:pathology*; D008327:Mammography / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis; D012042:Registries; D007507:Therapeutic Irrigation