Relevance and efficacy of breast cancer screening in BRCA1 and BRCA2 mutation carriers above 60 years: A national cohort study

Sepideh Saadatmand, Janet R. Vos, Maartje J. Hooning, Jan C. Oosterwijk, Linetta B. Koppert, Geertruida H. de Bock, Margreet G. Ausems, Christi J. van Asperen, Cora M. Aalfs, Encarna B. Gomez Garcia, Hanne Meijers-Heijboer, Nicoline Hoogerbrugge, Marianne Piek, Caroline Seynaeve, Cornelis Verhoef, Matti Rookus, Madeleine M. Tilanus-Linthorst*, Hereditary Breast Ovarian Canc Res

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2940-2949
Number of pages10
JournalInternational Journal of Cancer
Volume135
Issue number12
DOIs
Publication statusPublished - 15-Dec-2014

Keywords

  • BRCA1
  • BRCA2
  • breast cancer
  • screening
  • mammography
  • HIGH FAMILIAL RISK
  • OVARIAN-CANCER
  • SUSCEPTIBILITY GENE
  • MAMMOGRAPHY
  • SURVIVAL
  • SURVEILLANCE
  • WOMEN
  • MRI
  • AGE
  • MULTICENTER

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