title: Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC).
abstract: Adding MRI to annual mammography screening improves early breast cancer detection in women with familial risk or BRCA1/2 mutation, but breast cancer specific metastasis free survival (MFS) remains unknown. We compared MFS of patients from the largest prospective MRI Screening Study (MRISC) with 1:1 matched controls. Controls, unscreened if<50 years, and screened with biennial mammography if ≥50 years, were matched on risk category (BRCA1, BRCA2, familial risk), year and age of diagnosis. Of 2,308 MRISC participants, breast cancer was detected in 93 (97 breast cancers), who received MRI <2 years before breast cancer diagnosis; 33 BRCA1 mutation carriers, 18 BRCA2 mutation carriers, and 42 with familial risk. MRISC patients had smaller (87% vs. 52% <T2, p < 0.001), more often node negative (69% vs. 44%, p = 0.001) tumors and received less chemotherapy (39% vs. 77%, p < 0.001) and hormonal therapy (14% vs. 47%, p < 0.001) than controls. Median follow-up time was 9 years (range 0-14). Breast cancer metastasized in 9% (8/93) of MRISC patients and in 23% (21/93) of controls (p = 0.009). MFS was better in MRISC patients overall (log-rank p = 0.008, HR 0.36, 95% CI 0.16-0.80), with familial risk (log-rank p = 0.024, HR: 0.21, 95% CI 0.04-0.95), and in BRCA1 mutation carriers (log-rank p = 0.055, HR 0.30, 95% CI 0.08-1.13). MFS remained better in MRISC patients after lead time correction (log-rank p = 0.020, HR 0.40, 95% CI 0.18-0.90). Overall survival was non-significantly better in MRISC patients (log-rank p = 0.064, HR 0.51, CI 0.24-1.06). Annual screening with MRI and mammography improves metastasis free survival in women with BRCA1 mutation or familial predisposition.
authors.affiliation: Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Saadatmand
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Obdeijn
authors.affiliation: Department of Surgery, the Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Emiel J
authors.initials: EJ
authors.lastname: Rutgers
authors.affiliation: Department of Genetics, University Medical Center, Groningen University, Groningen, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Oosterwijk
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Tollenaar
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Gwendolyn H
authors.initials: GH
authors.lastname: Woldringh
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bergers
authors.affiliation: Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Eveline A
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Medical Oncology, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Maartje J
authors.initials: MJ
authors.lastname: Hooning
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Madeleine M
authors.initials: MM
authors.lastname: Tilanus-Linthorst
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000401:mortality*; D016022:Case-Control Studies; D005260:Female; D019398:Genes, BRCA1; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009154:Mutation; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies
keywords: BRCA1; BRCA2; breast cancer survival; familial cancer syndromes; screening