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Differences between screen-detected and interval breast cancers among BRCA mutation carriers

  • Melissa PilewskieEmail author
  • Emily C. Zabor
  • Elizabeth Gilbert
  • Michelle Stempel
  • Oriana Petruolo
  • Debra Mangino
  • Mark Robson
  • Maxine S. Jochelson
Clinical Trial

Abstract

Background

BRCA mutation carriers have an elevated lifetime breast cancer risk and remain at risk for interval cancer development. We sought to compare BRCA mutation carriers with screen-detected versus interval breast cancers.

Methods

Women with a known BRCA mutation prior to a breast cancer diagnosis were identified. Clinical and pathologic factors, and imaging within 18 months of diagnosis were compared among screen-detected versus interval cancers. Interval cancers were those detected by physical exam among women undergoing regular screening.

Results

Of 124 breast cancers, 92 were screen and 22 clinically detected, of which 11 were interval cancers among regular screeners, and 10 were incidentally found on prophylactic mastectomy. Women with interval cancers were younger, had lower body mass indexes, and were more likely to be Black than those with screen-detected cancers (p < 0.05). Interval cancers were all invasive, larger, more likely to be node positive, and more likely to require axillary lymph node dissection and chemotherapy (p < 0.05). No significant differences were seen by BRCA mutation, mammographic density, MRI background parenchymal enhancement, tumor grade, or receptor status between cohorts. Women screened with both mammogram and MRI had significantly lower proportions of interval cancers compared to women screened with only mammogram or MRI alone (p < 0.05).

Conclusions

Interval breast cancers among BRCA mutation carriers have worse clinicopathologic features than screen-detected tumors, and require more-aggressive medical and surgical therapy. Imaging with mammogram and MRI is associated with lower interval cancer development and should be utilized among this high-risk population.

Keywords

BRCA Interval breast cancer Screen-detected breast cancer Mutation carriers 

Notes

Acknowledgements

This study was presented in poster format at the 2018 ASCO Annual Meeting, 1–5 June, Chicago, IL.

Funding

This study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Compliance with ethical standards

Conflict of interest

Dr. Melissa Pilewskie, Emily C. Zabor, Elizabeth Gilbert, Michelle Stempel, Dr. Oriana Petruolo and Dr. Debra Mangino declare that they have no conflict of interest. Dr. Mark Robson discloses Consultant/Advisory roles with AstraZeneca, McKesson, and Pfizer, and research funding to his institution from AstraZeneca, AbbVie, Medication, Myriad, Invitae, Pfizer, and Tesaro. Dr. Maxine Jochelson has received lecture remuneration from General Electric.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Biostatistics Service, Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Breast Medicine Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

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