This thesis investigated the optimal modality in breast cancer (BC) screening in women at elevated BC risk (including: BRCA1/2 mutation carriers, women at familial risk without a known gene mutation), and women with dense breasts. In general, women are screened for BC between the ages of 50 and 75 with 2D mammography. However, the high risk groups of women need more frequent screening program due to the young age of onset. Simulation studies showed that annual screening with mammography and MIR from age 30 was the most effective. That is also true for women over age 50. It is noticeable that in women with a BRCA1 mutation under age 40 MRI screening alone can be sufficient while in women with a BRCA2 mutation, screening with both MRI and mammography is still needed. For women at familial risk, MRI and mammography increased the sensitivity while significantly increased false positive rate. In women aged 60 and over, only for those with a BRCA2 mutation and dense breast, , annual alternating mammography and MRI was cost-effective compared to annual mammography. In general 3D mammography, digital breast tomosynthesis has higher sensitivity than 2D mammography in screening and diagnostic. Specifically, this method is effective for screening women with dense breast. Our results suggest that women with a BRCA1 or a BRCA2 mutation cannot be treated as one group. This is important to have different screening strategies not only for different groups of high risk women, but also for those with dense breasts.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2018|