Women with breast cancer who carried the BRCA1 breast cancer mutation and who were enrolled in an MRI surveillance program saw an 80 percent reduction in breast cancer mortality compared to women who did not, according to a recent study published in JAMA Oncology.
“Breast MRI can be unpleasant for many women, and the anxiety that surrounds it is considerable. However, this study provides strong data that allows us to define just how effective such surveillance can be,” said Jeffrey Dungan, MD, chief of Clinical Genetics in the Department of Obstetrics and Gynecology and a co-author of the study.
Women who have mutations in the BRCA1 or BRCA2 gene will have a 70 percent risk of developing breast cancer over their lifetimes, according to recent data.
The American Cancer Society currently recommends that women with either mutation undergo annual MRIs starting at age 25, and then annual MRI screenings and mammograms starting from the age of 30 years to age 70 years. However, the impact of MRI surveillance alone on reducing mortality risk in this patient population has not yet been well studied.
“Studies that examine this question typically rely on questionnaires sent to patients who have agreed to participate in long-term observational studies, and so these rates may be higher than in the total group of women who have BRCA1/2 variants,” Dungan said.
In the current trial, 2,004 women with breast cancer and BRCA1 mutations and 484 women with breast cancer and BRCA2 mutations were enrolled from 59 health centers in 11 countries. Participants completed a baseline questionnaire between 1995 and 2015 and a follow-up questionnaire every two years to document their breast cancer screening histories, cancer incidence and vitals status.
Participants were also followed up from age 30 years, or from when the baseline questionnaire was completed, until age 75 years, the last follow-up, or death from breast cancer.
Of these participants, 70.6 percent of women had at least one screening MRI exam and 29.4 percent did not. After an average follow-up of 9.2 years, 13.8 percent of women had developed breast cancer and 1.4 percent died of breast cancer.
Overall, women with the BRCA1 mutation who underwent MRI surveillance had an 80 percent reduction in breast cancer mortality, compared to a 13 percent reduction for women with the BRCA2 mutation.
The results demonstrate that MRI breast surveillance in women with BRCA1 mutations should be strongly recommended by healthcare professionals, according to Dungan.
Moving forward, Dungan said the ongoing collection of MRI surveillance data, especially in underserved populations, is critical for early identification and improving care equity.
“The large majority of patients in this particular study were white women of European descent. We also know there are many women of all ancestries that have at-risk family histories indicating they should have BRCA1/2 testing. We need to do a better job at identifying them to offer testing and to get those carriers into life-saving surveillance protocols,” Dungan said.
This work was supported in part by grant 154275 from the Canadian Institutes of Health Research and the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, in partnership with the Canadian Cancer Society.