Relevance and efficacy of breast cancer screening in BRCA1 and BRCA2 mutation carriers above 60 years: a national cohort study.
Annual MRI and mammography is recommended for BRCA1/2 mutation carriers to reduce breast cancer mortality. Less intensive screening is advised ≥60 years, although effectiveness is unknown. We identified BRCA1/2 mutation carriers without bilateral mastectomy before age 60 to determine for whom screening ≥60 is relevant, in the Rotterdam Family Cancer Clinic and HEBON: a nationwide prospective cohort study. Furthermore, we compared tumour stage at breast cancer diagnosis between different screening strategies in BRCA1/2 mutation carriers ≥60. Tumours >2 cm, positive lymph nodes, or distant metastases at detection were defined as "unfavourable." Of 548 BRCA1/2 mutation carriers ≥60 years in 2012, 395 (72%) did not have bilateral mastectomy before the age of 60. Of these 395, 224 (57%) had a history of breast or other invasive carcinoma. In 136 BRCA1/2 mutation carriers, we compared 148 breast cancers (including interval cancers) detected ≥60, of which 84 (57%) were first breast cancers. With biennial mammography 53% (30/57) of carcinomas were detected in unfavourable stage, compared to 21% (12/56) with annual mammography (adjusted odds ratio: 4·07, 95% confidence interval [1.79-9.28], p = 0.001). With biennial screening 40% of breast cancers were interval cancers, compared to 20% with annual screening (p = 0.016). Results remained significant for BRCA1 and BRCA2 mutation carriers, and first breast cancers separately. Over 70% of 60-year old BRCA1/2 mutation carriers remain at risk for breast cancer, of which half has prior cancers. When life expectancy is good, continuation of annual breast cancer screening of BRCA1/2 mutation carriers ≥60 is worthwhile.
Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Sepideh
S
Saadatmand
Janet R
JR
Vos
Maartje J
MJ
Hooning
Jan C
JC
Oosterwijk
Linetta B
LB
Koppert
Geertruida H
GH
de Bock
Margreet G
MG
Ausems
Christi J
CJ
van Asperen
Cora M
CM
Aalfs
Encarna B
EB
Gómez Garcia
Hanne
H
Meijers-Heijboer
Nicoline
N
Hoogerbrugge
Marianne
M
Piek
Caroline
C
Seynaeve
Cornelis
C
Verhoef
Matti
M
Rookus
Madeleine M
MM
Tilanus-Linthorst
D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis; D009426:Netherlands; D011446:Prospective Studies; D012307:Risk Factors
D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
BRCA1; BRCA2; breast cancer; mammography; screening