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Open AccessArticle

Breast Cancer Mortality among Women with a BRCA1 or BRCA2 Mutation in a Magnetic Resonance Imaging Plus Mammography Screening Program

1
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
2
Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
3
Department of Radiology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
4
Marvelle Koffler Breast Centre, Mt. Sinai Hospital, Toronto, ON M5G 1X5, Canada
5
Department of Medical Imaging, University Health Network, Toronto, ON M5T 1W7, Canada
6
Women’s College Research Institute, University of Toronto, Toronto, ON M5G 1N8, Canada
*
Author to whom correspondence should be addressed.
Present address: Grand River Hospital, 835 King Street W, Kitchener, ON N2A 4W1, Canada.
Present address: Department of Radiology, North York General Hospital, Toronto, ON M2K 1E1, Canada.
§
Deceased.
Cancers 2020, 12(11), 3479; https://doi.org/10.3390/cancers12113479
Received: 12 October 2020 / Revised: 13 November 2020 / Accepted: 19 November 2020 / Published: 23 November 2020
(This article belongs to the Special Issue Changing Landscape of Hereditary Breast and Ovarian Cancer)
Women with a BRCA1 or BRCA2 gene mutation have up to an 80% lifetime risk of breast cancer unless their breasts are surgically removed, but many decline or defer surgery and choose screening, hoping that if cancer occurs, it will be detected at a curable stage. In this study 489 women with a BRCA1 or BRCA2 mutation aged from 25 to 65 years, who had never had breast or ovarian cancer, were screened annually with breast magnetic resonance imaging (MRI) in addition to mammography and were followed for an average of 13 years (range: 9 to 23 years). Ninety-five of the 489 women enrolled in the study had a bilateral preventive mastectomy in the follow-up period. Of the 91 women diagnosed with breast cancer, four died of breast cancer. The most common cause of death was ovarian cancer. For women with BRCA mutations who choose annual screening with MRI and mammography, the probability of dying of breast cancer within 20 years is 2%.
Annual breast magnetic resonance imaging (MRI) plus mammography is the standard of care for screening women with inherited BRCA1/2 mutations. However, long-term breast cancer-related mortality with screening is unknown. Between 1997 and June 2011, 489 previously unaffected BRCA1/2 mutation carriers aged 25 to 65 years were screened with annual MRI plus mammography on our study. Thereafter, participants were eligible to continue MRI screening through the high-risk Ontario Breast Screening Program. In 2019, our data were linked to the Ontario Cancer Registry of Cancer Care Ontario to identify all incident cancers, vital status and causes of death. Observed breast cancer mortality was compared to expected mortality for age-matched women in the general population. There were 91 women diagnosed with breast cancer (72 invasive and 19 ductal carcinoma in situ (DCIS)) with median follow-up 7.4 (range: 0.1 to 19.2) years. Four deaths from breast cancer were observed, compared to 2.0 deaths expected (standardized mortality ratio (SMR) 2.0, p = 0.14). For the 489 women in the study, the probability of not dying of breast cancer at 20 years from the date of the first MRI was 98.2%. Annual screening with MRI plus mammography is a reasonable option for women who decline or defer risk-reducing mastectomy. View Full-Text
Keywords: breast neoplasms; BRCA1 gene; BRCA2 gene; magnetic resonance imaging; screening; mortality breast neoplasms; BRCA1 gene; BRCA2 gene; magnetic resonance imaging; screening; mortality
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MDPI and ACS Style

Warner, E.; Zhu, S.; Plewes, D.B.; Hill, K.; Ramsay, E.A.; Causer, P.A.; Seely, J.; Jong, R.A.; Lenkov, P.; Elser, C.; Crystal, P.; Yaffe, M.J.; Giannakeas, V.; Sun, P.; Narod, S.A. Breast Cancer Mortality among Women with a BRCA1 or BRCA2 Mutation in a Magnetic Resonance Imaging Plus Mammography Screening Program. Cancers 2020, 12, 3479. https://doi.org/10.3390/cancers12113479

AMA Style

Warner E, Zhu S, Plewes DB, Hill K, Ramsay EA, Causer PA, Seely J, Jong RA, Lenkov P, Elser C, Crystal P, Yaffe MJ, Giannakeas V, Sun P, Narod SA. Breast Cancer Mortality among Women with a BRCA1 or BRCA2 Mutation in a Magnetic Resonance Imaging Plus Mammography Screening Program. Cancers. 2020; 12(11):3479. https://doi.org/10.3390/cancers12113479

Chicago/Turabian Style

Warner, Ellen; Zhu, Siqi; Plewes, Donald B.; Hill, Kimberley; Ramsay, Elizabeth A.; Causer, Petrina A.; Seely, Jean; Jong, Roberta A.; Lenkov, Pamela; Elser, Christine; Crystal, Pavel; Yaffe, Martin J.; Giannakeas, Vasily; Sun, Ping; Narod, Steven A. 2020. "Breast Cancer Mortality among Women with a BRCA1 or BRCA2 Mutation in a Magnetic Resonance Imaging Plus Mammography Screening Program" Cancers 12, no. 11: 3479. https://doi.org/10.3390/cancers12113479

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