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Controlled Clinical Trial
. 2011 May 1;29(13):1664-9.
doi: 10.1200/JCO.2009.27.0835. Epub 2011 Mar 28.

Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging

Ellen Warner  1 , Kimberley Hill, Petrina Causer, Donald Plewes, Roberta Jong, Martin Yaffe, William D Foulkes, Parviz Ghadirian, Henry Lynch, Fergus Couch, John Wong, Frances Wright, Ping Sun, Steven A Narod
Affiliations
Controlled Clinical Trial

Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging

Ellen Warner et al. J Clin Oncol. .

Abstract

Purpose: The sensitivity of magnetic resonance imaging (MRI) for breast cancer screening exceeds that of mammography. If MRI screening reduces mortality in women with a BRCA1 or BRCA2 mutation, it is expected that the incidence of advanced-stage breast cancers should be reduced in women undergoing MRI screening compared with those undergoing conventional screening.

Patients and methods: We followed 1,275 women with a BRCA1 or BRCA2 mutation for a mean of 3.2 years. In total, 445 women were enrolled in an MRI screening trial in Toronto, Ontario, Canada, and 830 were in the comparison group. The cumulative incidences of ductal carcinoma in situ (DCIS), early-stage, and late-stage breast cancers were estimated at 6 years in the cohorts.

Results: There were 41 cases of breast cancer in the MRI-screened cohort (9.2%) and 76 cases in the comparison group (9.2%). The cumulative incidence of DCIS or stage I breast cancer at 6 years was 13.8% (95% CI, 9.1% to 18.5%) in the MRI-screened cohort and 7.2% (95% CI, 4.5% to 9.9%) in the comparison group (P = .01). The cumulative incidence of stages II to IV breast cancers was 1.9% (95% CI, 0.2% to 3.7%) in the MRI-screened cohort and 6.6% (95% CI, 3.8% to 9.3%) in the comparison group (P = .02). The adjusted hazard ratio for the development of stages II to IV breast cancer associated with MRI screening was 0.30 (95% CI, 0.12 to 0.72; P = .008).

Conclusion: Annual surveillance with MRI is associated with a significant reduction in the incidence of advanced-stage breast cancer in BRCA1 and BRCA2 carriers.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Cumulative incidence of invasive breast cancer in magnetic resonance imaging (MRI) –screened cohort and comparison group.
Fig 2.
Fig 2.
Cumulative incidence of early-stage (stages 0 to I) breast cancer in magnetic resonance imaging (MRI) –screened cohort and comparison group (competing risk model).
Fig 3.
Fig 3.
Cumulative incidence of stages II to IV breast cancer in magnetic resonance imaging (MRI) –screened cohort and comparison group (competing risk model).
See this image and copyright information in PMC

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