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Outcomes of Multimodality Breast Screening for Women at Increased Risk of Familial Breast Cancer

World Journal of Surgery volume 34, pages 979–986 (2010)Cite this article

Abstract

Background

While population-based breast screening for women over the age of 50 years is a generally accepted and proven health strategy, the role of breast screening specifically among women at high risk of familial breast cancer has remained controversial. Indeed, there are very few services specifically offering a breast-screening program for women at high risk of familial breast cancer.

Methods

In 1999 a Familial Breast Cancer Screening Clinic (FBCSC) was established at the North Brisbane BreastScreen Queensland Service to provide a regular multimodality screening program utilizing clinical breast examination, breast ultrasound, and mammography for women at higher risk of hereditary breast cancer and with entry into the program commencing from the age of 30 years.

Results

Since its inception, a total of 2440 women have participated in the FBCSC. A total 7051 breast-screening examinations have been performed on these participants, with 53 breast cancers being diagnosed, including 8 in situ ductal carcinomas, 38 invasive ductal carcinomas, and 7 invasive lobular carcinomas. The mean size of the cancers was 16 mm (range = 1–45 mm), and of the 45 invasive cancers, 60% were less than or equal to 15 mm in size. The overall axillary node positive rate was 24.5% (13/53). The invasive cancer detection rate for first-round screening was 8.3 cancers per 1000 women screened, with 5.2 cancers per 1000 women detected on subsequent round screening.

Conclusions

The results from this service demonstrate that multimodality screening for women at high risk of familial breast cancer and including women of younger age is effective and appropriate, with very acceptable cancer detection rates and pathological cancer characteristics being observed consistent with early-stage detection. The colocated siting of this service within a BreastScreen Queensland facility has proven to be efficient and cost effective.

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Abbreviations

FBCSC:

Familial Breast Cancer Screening Clinic

NBOCC:

National Breast & Ovarian Cancer Centre

References

  1. Bennett IC, Gattas M, Teh B (2000) The management of familial breast cancer. Breast 9:247–263

    Article  CAS  PubMed  Google Scholar 

  2. Savven P (2004) Guidelines for the management of women at increased familial risk of breast cancer. Eur J Cancer 40:653–665

    Article  Google Scholar 

  3. Claus EB, Risch N, Thompson WD (1991) Genetic analysis of breast cancer in the Cancer and Steroid Hormone Study. Am J Hum Genet 48:232–242

    CAS  PubMed  Google Scholar 

  4. Watson M, Murday V, Lloyd S et al (1995) Genetic test in breast/ovarian cancer (BRCA1) families. Lancet 346(8974):583

    Article  CAS  PubMed  Google Scholar 

  5. Wooster R, Neuhausen S, Mangion J et al (1994) Localisation of a breast cancer susceptibility gene BRCA2 to chromosome 13q12-13. Science 265:2088–2090

    Article  CAS  PubMed  Google Scholar 

  6. Domchek S, Weber B (2004) Inherited genetic factors and breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne C (eds) Diseases of the breast, 3rd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 277–301; chap 17

    Google Scholar 

  7. Gail MH, Brinton LA, Byar DP et al (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879–1886

    Article  CAS  PubMed  Google Scholar 

  8. Claus EB, Risch N, Thompson WD (1994) Autosomal dominant inheritance of early-onset breast cancer. Implications for risk prediction. Cancer 73:643–651

    Article  CAS  PubMed  Google Scholar 

  9. Tyrer J, Duffy SW, Cuzick J (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23:1111–1130

    Article  PubMed  Google Scholar 

  10. Berry DA, Parmigiani G, Sanchez J et al (1997) Probability of carrying a mutation of breast-ovarian cancer gene BRCA1 based on family history. J Natl Cancer Inst 89:227–238

    Article  CAS  PubMed  Google Scholar 

  11. Antoniou AC, Pharoah PP, Smith P et al (2004) The BOADICEA model of genetic susceptibility to breast and ovarian cancer. Br J Cancer 91:1580–1590

    CAS  PubMed  Google Scholar 

  12. NHMRC National Breast & Ovarian Cancer Centre, Sydney, Australia (2006) Advice about familial aspects of breast cancer and ovarian cancer: a guide for health professionals. Available at http://www.nbcc.org.au

  13. Robson M, Offit K (2007) Management of an inherited predisposition to breast cancer. N Engl J Med 357:154–162

    Article  CAS  PubMed  Google Scholar 

  14. Humphrey LL, Helfand M, Chan BK et al (2002) Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:347–360

    PubMed  Google Scholar 

  15. Shapiro S, Venet W, Strax P et al (1982) Ten- to fourteen-year effects of breast cancer screening on mortality. J Natl Cancer Inst 69:349–355

    CAS  PubMed  Google Scholar 

  16. Tabar L, Fagerberg G, Chen H-H et al (1995) Efficacy of breast cancer screening by age. New results from the Swedish two-county trial. Cancer 75:2507–2517

    Article  CAS  PubMed  Google Scholar 

  17. Verbeek A (1985) Population screening for breast cancer in Nijmegen, an evaluation of the period 1975–1982. Publication of the Department of Social Medicine, Katholleke Universiteir, Nijmegen

    Google Scholar 

  18. Kerlikowske K, Carney PA, Geller B et al (2000) Performance of screening mammography among women with and without a first-degree relative with breast cancer. Ann Intern Med 133:855–863

    CAS  PubMed  Google Scholar 

  19. Macmillan RD (2000) Screening women with a family history of breast cancer—results from the British Familial Breast Cancer Group. Eur J Surg Oncol 26:149–152

    Article  CAS  PubMed  Google Scholar 

  20. Lalloo F, Boggis CR, Evans DG et al (1998) Screening by mammography, women with a family history of breast cancer. Eur J Cancer 34:937–940

    Article  CAS  PubMed  Google Scholar 

  21. Kollias J, Sibbering DM, Blamey RW et al (1998) Screening women aged less than 50 years with a family history of breast cancer. Eur J Cancer 34:878–883

    Article  CAS  PubMed  Google Scholar 

  22. Chart PL, Franssen E (1997) Management of women at increased risk of breast cancer: preliminary results from a new program. CMAJ 157:1235–1242

    CAS  PubMed  Google Scholar 

  23. Møller P, Reis MM, Evans G et al (1999) Efficacy of early diagnosis and treatment in women with a family history of breast cancer. European Familial Breast Cancer Collaborative Group. Dis Markers 15:179–186

    PubMed  Google Scholar 

  24. Tilanus-Linthorst MM, Bartels CC, Obdeijn AI et al (2000) Earlier detection of breast cancer by surveillance or women at familial risk. Eur J Cancer 36:514–519

    Article  CAS  PubMed  Google Scholar 

  25. Brekelmans CT, Seynaeve C, Bartels CC et al (2001) Effectiveness of breast screening surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol 19:924–930

    CAS  PubMed  Google Scholar 

  26. Gui GP, Hogben RK, Walsh G et al (2001) The incidence of breast cancer from screening women according to predicted family history risk: does annual clinical examination add to mammography? Eur J Cancer 37:1668–1673

    Article  CAS  PubMed  Google Scholar 

  27. Murday V, Pears R, Ball J et al (2004) An audit of screening for familial breast cancer before 50 years in the South Thames Region—have we got it right? Fam Cancer 3:28–34

    Google Scholar 

  28. Kriege M, Brekelmans CT, Boetes C et al (2004) Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437

    Article  CAS  PubMed  Google Scholar 

  29. Warner E, Plewes DB, Hill KA et al (2004) Surveillance of BRCA1 and BRCA2 mutation carriers with MRI, ultrasound, mammography and clinical breast examination. JAMA 292:1317–1325

    Article  CAS  PubMed  Google Scholar 

  30. Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476

    Article  PubMed  Google Scholar 

  31. Leach MO, Boggis CR, Dixon AK et al (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study. Lancet 365:1769–1778

    Article  CAS  PubMed  Google Scholar 

  32. Lehman CD, Blume JD, Weatherall P et al (2005) Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 103:1898–1905

    Article  PubMed  Google Scholar 

  33. Sardanelli F, Podo F, D’Agnolo G et al (2007) Multicentre comparative multinodularity surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT Study): interim results. Radiology 242:698–715

    Article  PubMed  Google Scholar 

  34. Elwood JM, Cox B, Rickhardson AK (1992) The effectiveness of breast cancer screening by mammography in younger women. Report prepared for the Hugh Adam Cancer Epidemiology Unit, Department of Health New Zealand

  35. Smart CR, Hendrick RE, Rutledge JH et al (1995) Benefit of mammographic screening on women aged 40–49 current evidence from randomized controlled trials. Cancer 75:1619–1626

    Article  CAS  PubMed  Google Scholar 

  36. Narod SA, Lubinski J, Ghadirian P et al (2006) Screening mammography and risk of breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Lancet Oncol 7(5):402–406; erratum: Lancet Oncol 7(6):453

    Article  CAS  PubMed  Google Scholar 

  37. BreastScreen Australia National Accreditation Standards (2004) Developed by National Quality Management Committee of BreastScreen Australia. Revisions endorsed by Australian Screening Advisory Committee

  38. Tabar L, Fagerberg G, Duffy SW et al (1992) Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 30:187–210

    CAS  PubMed  Google Scholar 

  39. Foxcroft LM, Evans EB, Porter AJ (2004) The diagnosis of breast cancer in women younger than 40. Breast 13:297–306

    Article  CAS  PubMed  Google Scholar 

  40. Ciatto S, Rosselli del Turco M, Catarzi S et al (1994) The diagnostic role of breast echography. Radiol Med 88:221–224

    CAS  PubMed  Google Scholar 

  41. Leconte I, Feger C, Galant C et al (2003) Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol 180:1675–1679

    PubMed  Google Scholar 

  42. Houssami N, Irwig L, Simpson JM et al (2003) Sydney breast imaging accuracy study: comparative sensitivity and specificity of mammography and sonography in young women with symptoms. AJR Am J Roentgenol 180:935–940

    PubMed  Google Scholar 

  43. Crystal P, Strano S, Shcharynski S et al (2003) Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 181:177–182

    PubMed  Google Scholar 

  44. Anderson J, Walker LG, Leach MO (2004) Magnetic resonance imaging: an acceptable way of screening women with a family history of breast cancer. Breast Cancer Res Treat 88(Suppl):S188

    Google Scholar 

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Author information

Affiliations

  1. Department of Surgery, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia

    Ian C. Bennett

  2. Cancer Screening Services, Queensland Health, Brisbane, QLD, Australia

    Jennifer Muller

  3. BreastScreen Queensland, North Brisbane Service, Chermside, Brisbane, QLD, Australia

    Linda Cockburn, Helen Joshua, Christine Baker, Nili Wood & Jane Brazier

  4. Familial Breast Cancer Screening Clinic, BreastScreen Queensland, North Brisbane Service, Chermside, Brisbane, QLD, Australia

    Gillian Thorley

  5. School of Population Health, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia

    Mark Jones

  6. Monitoring, BreastScreen Queensland, Queensland Health, Brisbane, QLD, Australia

    Nathan Dunn

  7. Queensland Clinical Genetics Service, Royal Brisbane Hospital, Herston, Brisbane, QLD, 4006, Australia

    Michael Gattas

  8. Silverton Place, 101 Wickham Terrace, Brisbane, QLD, 4000, Australia

    Ian C. Bennett

Authors
  1. Ian C. Bennett
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  2. Jennifer Muller
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  3. Linda Cockburn
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  4. Helen Joshua
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  5. Gillian Thorley
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  6. Christine Baker
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  7. Nili Wood
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  8. Jane Brazier
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  9. Mark Jones
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  10. Nathan Dunn
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  11. Michael Gattas
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Correspondence to Ian C. Bennett.

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Bennett, I.C., Muller, J., Cockburn, L. et al. Outcomes of Multimodality Breast Screening for Women at Increased Risk of Familial Breast Cancer. World J Surg 34, 979–986 (2010). https://doi.org/10.1007/s00268-010-0409-4

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Keywords

  • Breast Cancer
  • Familial Breast Cancer
  • Breast Screening
  • Interval Cancer
  • Hereditary Breast Cancer