Triple-Negative versus Non-Triple-Negative Breast Cancers in High-Risk Women: Phenotype Features and Survival from the HIBCRIT-1 MRI-Including Screening Study.
OBJECTIVE
To compare phenotype features and survival of triple-negative breast cancers (TNBC) versus non-TNBCs detected during a multimodal annual screening of high-risk women.


METHODS
Analysis of data from asymptomatic high-risk women diagnosed with invasive breast cancer during the HIBCRIT-1 study with median 9.7-year follow-up.


RESULTS
Of 501 enrolled women with BRCA1/2 mutation or strong family history (SFH), 44 were diagnosed with invasive breast cancers: 20 BRCA1 (45%), 9 BRCA2 (21%), 15 SFH (34%). Magnetic resonance imaging (MRI) sensitivity (90%) outperformed that of mammography (43%, P < 0.001) and ultrasonography (61%, P = 0.004). The 44 cases (41 screen-detected; 3 BRCA1-associated interval TNBCs) comprised 14 TNBCs (32%) and 30 non-TNBCs (68%), without significant differences for age at diagnosis, menopausal status, prophylactic oophorectomy, or previous breast cancer. Of 14 TNBC patients, 11 (79%) were BRCA1; of the 20 BRCA1 patients, 11 (55%) had TNBC; and of 15 SFH patients, 14 (93%) had non-TNBCs (P = 0.007). Invasive ductal carcinomas (IDC) were 86% for TNBCs versus 43% for non-TNBCs (P = 0.010), G3 IDCs 71% versus 23% (P = 0.006), size 16 ± 5 mm versus 12 ± 6 mm (P = 0.007). TNBC patients had more frequent ipsilateral mastectomy (79% vs. 43% for non-TNBCs, P = 0.050), contralateral prophylactic mastectomy (43% vs. 10%, P = 0.019), and adjuvant chemotherapy (100% vs. 44%, P < 0.001). The 5-year overall survival was 86% ± 9% for TNBCs versus 93% ± 5% (P = 0.946) for non-TNBCs; 5-year disease-free survival was 77% ± 12% versus 76% ± 8% (P = 0.216).


CONCLUSIONS
In high-risk women, by combining an MRI-including annual screening with adequate treatment, the usual reported gap in outcome between TNBCs and non-TNBCs could be reduced.
Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy. franca.podo@alice.it.
Franca
F
Podo
Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy.
Filippo
F
Santoro
Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy.
Giovanni
G
Di Leo
Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Siranoush
S
Manoukian
Department of Medical Oncology, CRO-Centro di Riferimento Oncologico, Aviano (PN), Italy.
Clelia
C
de Giacomi
Breast Imaging Unit, Sant'Anna Universitary Hospital, Cona (FE), Italy.
Stefano
S
Corcione
Department of Oncology and Haematology, Azienda Ospedaliera Policlinico, Modena, Italy.
Laura
L
Cortesi
Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy.
Luca A
LA
Carbonaro
Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy.
Rubina M
RM
Trimboli
Radiological Section, Ospedale Santa Chiara, University of Pisa, Pisa, Italy.
Anna
A
Cilotti
Division of Radiology, European Institute of Oncology, Milan, Italy.
Lorenzo
L
Preda
Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy.
Bernardo
B
Bonanni
Department of Clinical Medicine and Surgery, Clinical Unit of "Hereditary and Familial Cancers", University Hospital Federico II, Naples, Italy.
Matilde
M
Pensabene
Unit of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy.
Laura
L
Martincich
Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy.
Antonella
A
Savarese
Department of Clinical Medicine and Surgery, Clinical Unit of "Hereditary and Familial Cancers", University Hospital Federico II, Naples, Italy.
Alma
A
Contegiacomo
Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
Francesco
F
Sardanelli
D000328:Adult; D000368:Aged; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010641:Phenotype; D012306:Risk; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy