Women With BRCA1/2 May Need Mammogram More Than Once Each Year Laurie Barclay, MD Many women with BRCA1 or BRCA2 genetic mutations develop breast cancer at a mean of five months after having a normal mammogram, according to the results of a retrospective chart review study published online in the April 12 issue of Cancer. This may suggest the need for screening more frequently than every 12 months, as is currently advocated. "At present, there is no consensus regarding how frequently BRCA mutation carriers should be screened for malignancies using breast imaging techniques," write Ian Komenaka and colleagues, from the Columbia-Presbyterian Medical Center in New York City. Issues relevant to optimal screening frequency include the 60% to 85% lifetime risk of developing breast cancer in women with BRCA mutations; the availability of preventive measures, including chemoprevention with tamoxifen or prophylactic mastectomy; and surveillance techniques, including annual screening mammography or ultrasound, monthly breast self-examination, clinical examination by a health professional every four to six months, and breast magnetic resonance imaging. Annual screening mammography is thought to be associated with reduced mortality from breast cancer in women older than 50 years, but the role and optimal frequency of this procedure in high-risk women is still controversial. Although most guidelines suggest annual screening mammograms five to 10 years before the age of onset of the youngest affected relative, this is based on expert opinion rather than evidence-based medicine. Nor is there any consensus on the use of ultrasound or other radiological tests. Based on chart review of 13 women with BRCA mutations, four (31%) of the 13 women who opted for close surveillance developed breast cancer detected by annual screening mammography, but six others (46%) had developed palpable interval cancers between their annual mammograms. Most of these tumors were invasive cancers with metastases to regional lymph nodes at presentation. In these six patients, the mean time from last mammogram screening was 5.1 months, and the average tumor size was 1.7 cm. "These short durations all suggest that annual mammography may be inadequate for breast screening in this population," the authors write, while acknowledging study limitations of small sample size, limited power, and retrospective design. "Strong consideration should be given to screening BRCA-positive women at more frequent intervals and to using additional imaging techniques, such as breast ultrasonography and/or breast magnetic resonance imaging, as a part of this screening." Cancer. Published online April 12, 2004. Reviewed by Gary D. Vogin, MD Thanks to MEDSCAPE.com From: AnnFonfa@aol.com To: Ian Komenka Subject: Questions on your recent paper? Date: Sun, 9 May 2004 12:13:09 EDT "The development of interval breast malignancies in patients with BRCA mutations" 1. Were the women being followed told that their mammograms showed dense breast tissue? (All six patients who developed interval disease exhibited dense breast tissue on the previous mammogram. Focused breast ultrasonography was able to identify the tumor mass in 3 of 4 patients (75%).) 2. Why more frequent, why not just use the variety of modalities? It may lead to less exposure to ionizing radiation in the subset of our population more susceptible to breast cancer. We are interested in your reply. Thank you. Dr. Ian Komenaka responds: The radiologists, oncologists, and surgeons typically inform the patients about the findings, including the density of their breasts. I cannot say for sure because this was a retrospective review and some of the studies were done years before I arrived at the medical center. It seems that 12 month intervals are inadequate because the average time to develop a new breast mass on physical examination was 5 months. Currently at Columbia, we do use a variety of imaging modalities every 4 months. There has yet to be a study finding another screening modality that could replace/substitute for annual mammography. But until more data is available, more definitive recommendations cannot be made. Thank you for your interest Ian Komenaka, MD Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.