Mammographic surveillance in women aged 35–39 at enhanced familial risk of breast cancer (FH02)

Abstract

Although there have been encouraging recent studies showing a potential benefit from annual mammography in women aged 40-49 years of age with an elevated breast cancer risk due to family history there is little evidence of efficacy in women aged <40 years of age. A prospective study (FH02) has been developed to assess the efficacy of mammography screening in women aged 35-39 years of age with a lifetime breast cancer risk of ≥ 17 % who are not receiving MRI screening. Retrospective analyses from five centres with robust recall systems identified 47 breast cancers (n = 12 in situ) with an interval cancer rate of 15/47 (32%). Invasive tumour size, lymph node status and current vital status were all significantly better than in two control groups of unscreened women (including those with a family history) recruited to the POSH study. Further evaluation of the prospective arm of FH02 is required to assess the potential added value of digital mammography and the cancer incidence rates in moderate and high risk women in order to inform cost effectiveness analyses.

Tumour characteristics and survival in familial breast cancer prospectively diagnosed by annual mammography

“…However, it is of note that the 88 % 10-year survival for invasive breast cancer compares favourably to the 71.5 % 10-year survival for all women in the UK diagnosed in 2000–2001 [16] approximating to the median age at diagnosis in our report. Survival in unscreened family history positive women diagnosed with breast cancer in the UK under 40 years of age between 2000 and 2008 was poor in a recent study with only 70 % being alive without metastasis at a mean of 7-year follow-up [16] and with 8-year overall survival of only 67.3 % for all women [15]. Also, 10 year survival was better in the group described here than in inherited breast cancer caused by BRCA1 mutations [17].…”

The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services

“…To assess the potential effects of the Angelina Jolie effect, referral data specific to breast cancer family history was obtained from around the UK for the years 2012 and 2013. A consortium of 34 breast cancer FHCs that have contributed to two research studies on early breast surveillance [ 13 ],[ 14 ] were asked to participate. Likewise 10/19 of the Regional Genetics Centres (RGCs) that were approached had cancer-specific referral data (one of the centres could not separate breast from other cancers) and were invited (Table 1 ).…”

Targeting breast cancer outcomes‐what about the primary relatives?

“…Attempts have been made to tailor care to individuals rather than blanket cohorts of the population (Evans et al. , ). Family history is a very important assessment tool in detecting those at risk (Welch et al.…”

“…This screening is costly and discussions regarding over diagnosis are common (Rashidian et al 2013;Arrospide et al 2016;Rafia et al 2016;Swain et al 2016). Attempts have been made to tailor care to individuals rather than blanket cohorts of the population (Evans et al 2012(Evans et al , 2014. Family history is a very important assessment tool in detecting those at risk (Welch et al 2015).…”