Intensive breast screening in BRCA2 mutation carriers is associated with reduced breast cancer specific and all cause mortality

D G Evans; E F Harkness; A Howell; M Wilson; E Hurley; M M Holmen; K U Tharmaratnam; A I Hagen; Y Lim; A J Maxwell; P Moller

doi:10.1186/s13053-016-0048-3

Intensive breast screening in BRCA2 mutation carriers is associated with reduced breast cancer specific and all cause mortality

Hered Cancer Clin Pract. 2016 Apr 14:14:8. doi: 10.1186/s13053-016-0048-3. eCollection 2016.

Authors

D G Evans¹, E F Harkness², A Howell³, M Wilson³, E Hurley³, M M Holmen⁴, K U Tharmaratnam⁵, A I Hagen⁶, Y Lim³, A J Maxwell³, P Moller⁷

Affiliations

¹ Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK ; Genomic Medicine, St Mary's Hospital, Oxford Road, Manchester Academic Health Sciences Centre, University of Manchester Institute of Human Development, Central, Manchester Foundation Trust, Manchester, M13 9WL UK.
² Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK ; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL UK.
³ Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK.
⁴ Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁵ Department of Mathematics, University of Oslo, Blindern, Oslo, Norway.
⁶ Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway ; Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁷ Inherited Cancer Research Group, The Norwegian Radium Hospital, Department for Medical Genetics, Oslo University Hospital, Oslo, Norway ; Department of Tumour Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway ; Department of Human Medicine, Universität Witten/Herdecke, Witten, Germany.

Abstract

Background: The addition of annual MRI screening to mammography has heightened optimism that intensive screening along with improved treatments may substantially improve life expectancy of women at high risk of breast cancer. However, survival data from BRCA2 mutation carriers undergoing intensive combined breast screening are scarce.

Methods: We have collated the results of screening with either annual mammography or mammography with MRI in female BRCA2 mutation carriers in Manchester and Oslo and use a Manchester control group of BRCA2 mutation carriers who had their first breast cancer diagnosed without intensive screening.

Results: Eighty-seven BRCA2 mutation carriers had undergone combined (n = 34) or mammography (n = 53) screening compared to 274 without such intensive screening. Ten year breast cancer specific survival was 100 % in the combined group (95 % CI 82.5-100 %) and 85.5 % (95 % CI 72.6-98.4 %) in the mammography group compared to 74.6 % (95 % CI 66.6-82.6 %) in the control group. Better survival was driven by lymph node status (negative in 67 % of screened vs 39 % of unscreened women; p < 0.001) and a significantly greater proportion of intensively screened women had invasive breast cancers <2 cm at diagnosis (74.6 % vs 50.4 %; p = 0.002).

Conclusion: Intensive combined breast cancer screening with annual MRI and mammography appears to improve survival from breast cancer in BRCA2 mutation carriers. Data from larger groups are required to confirm the effectiveness of combined screening in BRCA2 carriers.

Keywords: BRCA2; Breast cancer; Kaplan-meier; MRI; Mammography; Survival.