title: Long-term results of screening with magnetic resonance imaging in women with BRCA mutations.
abstract: BACKGROUND
  The addition of breast magnetic resonance imaging (MRI) to screening mammography for women with BRCA mutations significantly increases sensitivity, but there is little data on clinical outcomes. We report screening performance, cancer stage, distant recurrence rate, and breast cancer-specific mortality in our screening study.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
authors.forename: K
authors.initials: K
authors.lastname: Passaperuma
authors.forename: E
authors.initials: E
authors.lastname: Warner
authors.forename: P A
authors.initials: PA
authors.lastname: Causer
authors.forename: K A
authors.initials: KA
authors.lastname: Hill
authors.forename: S
authors.initials: S
authors.lastname: Messner
authors.forename: J W
authors.initials: JW
authors.lastname: Wong
authors.forename: R A
authors.initials: RA
authors.lastname: Jong
authors.forename: F C
authors.initials: FC
authors.lastname: Wright
authors.forename: M J
authors.initials: MJ
authors.lastname: Yaffe
authors.forename: E A
authors.initials: EA
authors.lastname: Ramsay
authors.forename: S
authors.initials: S
authors.lastname: Balasingham
authors.forename: L
authors.initials: L
authors.lastname: Verity
authors.forename: A
authors.initials: A
authors.lastname: Eisen
authors.forename: B
authors.initials: B
authors.lastname: Curpen
authors.forename: R
authors.initials: R
authors.lastname: Shumak
authors.forename: D B
authors.initials: DB
authors.lastname: Plewes
authors.forename: S A
authors.initials: SA
authors.lastname: Narod
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009154:Mutation; D012680:Sensitivity and Specificity