MRI and Mammography Surveillance of Women at Increased Risk for Breast Cancer

Granader, Elon J.; Dwamena, Ben A.; Carlos, Ruth C.

doi:10.1016/j.acra.2008.06.006

Cited by 34 publications

(10 citation statements)

References 16 publications

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“…Prophylactic oophorectomy is more widely accepted than mastectomy [17, 18]. We found that recommendations for prophylactic surgery are not limited to the physician groups performing the operation as GS and OG were second to HO in recommending prophylactic surgeries potentially reflecting experience and/or specialized knowledge of the HO physicians with the NCCN guidelines [19, 20]. …”

Section: Discussionmentioning

confidence: 99%

Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

Dhar

Cooper

Wang

et al. 2011

Breast Cancer Res Treat

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The National Comprehensive Cancer Network (NCCN) has published guidelines for hereditary breast and ovarian cancer syndrome (HBOCS) management. Little data exist on compliance with these guidelines among different physician specialties. We performed an on-line case-based survey by randomly sampling physicians from five specialties, Family Medicine (FM), Obstetrics and Gynecology (OG), General Surgery (GS), Internal Medicine (IM), and Hematology and Oncology (HO). The physicians (n = 225) were asked to provide HBOCS management of healthy women ages 40–42 in the presence of a familial BRCA1 mutation. For women negative for the BRCA1 mutation, 59% of the physicians recommended appropriate surveillance although with significant differences among specialties; P = 0.01. Using an aggregate screening intensity score, physicians clearly recommended more intense screening for mutation positive than negative women (P < 0.0001), but only 16% of physicians followed NCCN guidelines for BRCA1-positive women. Seventy-six percent of all physicians recommended breast MRI with significant variation among specialties ranging from 62% of FM to 89% of OG (P = 0.0020). Similarly, 63% of physicians recommended prophylactic oophorectomy, with 76 and 78% of GS and OG compared to 38% of IM (P < 0.0001) and 57% recommended prophylactic mastectomy ranging from 84% of HO to 32% of FM (P < 0.0001). Independent of specialty, respondents with BRCA testing experience recommended more intense management than those without; P = 0.021. Management recommendations of BRCA1 mutation carriers are not consistent with NCCN guidelines and vary by medical specialty and genetic testing experience. Targeted education of physicians by specialty is needed, so that optimal management is offered to these high-risk women.

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Section: Discussionmentioning

confidence: 99%

Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

Dhar

Cooper

Wang

et al. 2011

Breast Cancer Res Treat

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“…An analogy would be BRCA 1 and 2 mutation carriers, who have a high risk for cancers at a young age, and with a more aggressive phenotype. Such women are screened annually with mammography and MRI annually, staggered at 6-month intervals [28, 29]. …”

Section: Discussionmentioning

confidence: 99%

Locally advanced breast cancers are more likely to present as Interval Cancers: results from the I-SPY 1 TRIAL (CALGB 150007/150012, ACRIN 6657, InterSPORE Trial)

Lin

Buxton

Moore

et al. 2011

Breast Cancer Res Treat

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Interval cancers (ICs), defined as cancers detected between regular screening mammograms, have been shown to be of higher grade, larger size, and associated with lower survival, compared with screen-detected cancers (SDCs) and comprise 17% of cancers from population-based screening programs. We sought to determine the frequency of ICs in a study of locally advanced breast cancers, the I-SPY 1 TRIAL. Screening was defined as having a mammogram with 2 years, and the proportion of ICs at 1 and 2 years was calculated for screened patients. Differences in clinical characteristics for ICs versus SDCs and screened versus non-screened cancers were assessed. For the 219 evaluable women, mean tumor size was 6.8 cm. Overall, 80% of women were over 40 and eligible for screening; however, only 31% were getting screened. Among women screened, 85% were ICs, with 68% diagnosed within 1 year of a previously normal mammogram. ICs were of higher grade (49% vs. 10%) than SDCs. Among non-screened women, 28% (43/152) were younger than the recommended screening age of 40. Of the entire cohort, 12% of cancers were mammographically occult (MO); the frequency of MO cancers did not differ between screened (11%) and non-screened (15%). ICs were common in the I-SPY 1 TRIAL suggesting the potential need for new approaches beyond traditional screening to reduce mortality in women who present with larger palpable cancers.

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“…Perhaps the most important limitation to breast MRI relates to its low specificity, which has been found to range widely from 75% to 98% (compared with a specificity of 91% to 100% for mammography), although the prognostic value becomes more favorable in women with high familial risk and/or a BRCA1/ 2 gene mutation (18,19). The decreased specificity of MRI often leads to additional investigation and work-up, which may include potentially unnecessary biopsies.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Breast Cancer Risk Distribution for Women Undergoing Screening in British Columbia

Weisstock¹,

Rajapakshe²,

Bitgood³

et al. 2013

Cancer Prevention Research

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Breast cancer risk estimations are both informative and useful at the population level, with many screening programs relying on these assessments to allocate resources such as breast MRI. This crosssectional multicenter study attempts to quantify the breast cancer risk distribution for women between the ages of 40 to 79 years undergoing screening mammography in British Columbia (BC), Canada. The proportion of women at high breast cancer risk was estimated by surveying women enrolled in the Screening Mammography Program of British Columbia (SMPBC) for known breast cancer risk factors. Each respondent's 10-year risk was computed with both the Tyrer-Cuzick and Gail risk assessment models. The resulting risk distributions were evaluated using the guidelines from the National Institute for Health and Care Excellence (United Kingdom). Of the 4,266 women surveyed, 3.5% of women between the ages of 40 to 79 years were found to have a high 10-year risk of developing breast cancer using the Tyrer-Cuzick model (1.1% using the Gail model). When extrapolated to the screening population, it was estimated that 19,414 women in the SMPBC are considered to be at high breast cancer risk. These women may benefit from additional MRI screening; preliminary analysis suggests that 4 to 5 additional MRI machines would be required to screen these high-risk women. However, the use of different models and guidelines will modify the number of women qualifying for additional screening interventions, thus impacting the MRI resources required. The results of this project can now be used to inform decision-making groups about resource allocation for breast cancer screening in BC. Cancer Prev Res; 6(10); 1084-92. Ó2013 AACR.

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MRI and Mammography Surveillance of Women at Increased Risk for Breast Cancer

Cited by 34 publications

References 16 publications

Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

Locally advanced breast cancers are more likely to present as Interval Cancers: results from the I-SPY 1 TRIAL (CALGB 150007/150012, ACRIN 6657, InterSPORE Trial)

Assessing the Breast Cancer Risk Distribution for Women Undergoing Screening in British Columbia

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