A new study finds women with genetic mutations that raise the risk of breast cancer often developed advanced disease within six months of a normal annual screening mammogram, indicating annual exams may not be adequate in these women.
The results of the study, published in the journal Cancer, demonstrate that more frequent breast cancer screening with mammography and/or ultrasound is necessary for women with the BRCA1 and BRCA2 mutations.
Women with BRCA mutations have a 60 to 85 percent lifetime risk of developing breast cancer. Women who know they carry the gene can make informed options about how to lower their risk, including chemoprevention using Tamoxifen, or prophylactic mastectomy, surgery to remove breast tissue. Some women also choose close surveillance by: annual screening mammography or ultrasound; monthly breast self- exam; clinical exam by a health professional every four to six months; and consideration for breast MRI.
While annual screening mammography has reduced mortality from breast cancer in women over 50, its role and frequency for high-risk women is controversial. Most guidelines suggest annual screening mammograms five to 10 years prior to the age of the youngest affected relative. However, this is based on expert opinion rather than evidence-based medicine. Moreover, there is no consensus on the use of other radiological diagnostic tools, such as ultrasound.
Drs. Ian Komenaka, Beth Ann Ditkoff, and colleagues from Columbia-Presbyterian Medical Center in New York, reviewed the charts of 13 BRCA mutation carrier patients, to find out how those chose close surveillance fared.
While four of the 13 women who chose close surveillance developed breast cancer that was detected by annual screening mammography, six others had developed breast cancer between their annual mammograms. The mean time from last mammogram screening in these women was 5.1 months, and the average tumor size was 1.7cm. Most were invasive cancers involving regional lymph nodes at presentation.
The authors conclude: "These short durations all suggest that annual mammography may be inadequate for breast screening in this population."
SOURCE:
Cancer, May 15, 2004, published online April 12, 2004
