Differences between screen-detected and interval breast cancers among BRCA mutation carriers

Abstract

Background-BRCA mutation carriers have an elevated lifetime breast cancer risk and remain at risk for interval cancer development. We sought to compare BRCA mutation carriers with screen-detected versus interval breast cancers. Methods-Women with a known BRCA mutation prior to a breast cancer diagnosis were identified. Clinical and pathologic factors, and imaging within 18 months of diagnosis were compared among screen-detected versus interval cancers. Interval cancers were those detected by physical exam among women undergoing regular screening. Results-Of 124 breast cancers, 92 were screen and 22 clinically detected, of which 11 were interval cancers among regular screeners, and 10 were incidentally found on prophylactic mastectomy. Women with interval cancers were younger, had lower body mass indexes, and were more likely to be Black than those with screen-detected cancers (p<0.05). Interval cancers were all invasive, larger, more likely to be node positive, and more likely to require axillary lymph node dissection and chemotherapy (p<0.05). No significant differences were seen by BRCA mutation, mammographic density, MRI background parenchymal enhancement, tumor grade, or receptor status between cohorts. Women screened with both mammogram and MRI had significantly lower proportions of interval cancers compared to women screened with only mammogram or MRI alone (p<0.05). Conclusions-Interval breast cancers among BRCA mutation carriers have worse clinicopathologic features than screen-detected tumors, and require more-aggressive medical and surgical therapy. Imaging with mammogram and MRI is associated with lower interval cancer development and should be utilized among this high-risk population.

Long-term survival of screen-detected synchronous and metachronous bilateral non-palpable breast cancer among Chinese women: a hospital-based study (2003–2017)

“…Breast cancer (BC) is the commonest malignancy worldwide and the leading cause of cancer death in Chinese women younger than 45 years [ 1 – 3 ]. It is well established that screen-detected BC has favorable biological behavior and prognosis compared to symptomatic interval breast cancer [ 4 – 6 ], which is also true in our previous study on screen-detected non-palpable breast cancer (NPBC) among Chinese asymptomatic women [ 7 ]. Meanwhile, we showed in our previous meta-analysis that bilateral breast cancer (BBC), especially synchronous BBC (SBBC) had worse survival compared to unilateral BC (UBC) [ 8 ].…”

“…BRCA mutation rate was about 24% among Chinese women with BBC [ 22 ]. Interval breast cancers among BRCA mutation carriers have worse clinicopathologic features than screen-detected tumors, and require more aggressive medical and surgical therapy [ 6 ]. Association between BRCA mutation and survival of BBC and screen-detected BBC would be further studied in our future research.…”

Comparison of Mortality Among Participants of Women’s Health Initiative Trials With Screening-Detected Breast Cancers vs Interval Breast Cancers

“…Use of magnetic resonance imaging can lower the rate of IBCs among high-risk populations. 44,45 Also, the combination of germline genomic testing with mammography may help distinguish indolent breast cancers from aggressive breast cancers detected by screening. 7 This study adds to a growing body of literature [46][47][48][49] that argues for the development of novel approaches to detect life-threatening cancers currently missed by mammographic screening.…”

Controversies and Open Questions in Management of Cancer-Free Carriers of Germline Pathogenic Variants in BRCA1/BRCA2

“…However, there are no data indicating survival advantage with MG as a sole breast imaging modality in BRCA P/LPV carriers. The lower sensitivity of MG may be attributed to younger median age at diagnosis, a time in a woman’s life when breast density is high [ 87 ], biologically more aggressive tumors [ 88 ], and higher rates of interval tumors [ 89 ]. Tomosynthesis is not routinely recommended, but extrapolating from average-risk population data, is to be considered according to several of the guidelines ( Table 2 ), given increased cancer detection rates and decreased false-positive recall rates, especially for those younger than 50 years of age [ 90 , 91 , 92 ].…”