MRI Surveillance and Breast Cancer Mortality in Women With BRCA1 and BRCA2 Sequence Variations
Por:
Lubinski, J, Kotsopoulos, J, Moller, P, Pal, T, Eisen, A, Peck, L, Karlan, BY, Aeilts, A, Eng, C, Bordeleau, L, Foulkes, WD, Tung, N, Couch, FJ, Fruscio, R, Cajal, T, Singer, CF, Neuhausen, SL, Zakalik, D, Cybulski, C, Gronwald, J, Huzarski, T, Stempa, K, Dungan, J, Cullinane, C, Olopade, OI, Metcalfe, K, Sun, P, Narod, SA
Publicada:
18 abr 2024
Ahead of Print:
1 abr 2024
Resumen:
ImportanceMagnetic resonance imaging (MRI) surveillance is offered to women with a pathogenic variant in the BRCA1 or BRCA2 gene who face a high lifetime risk of breast cancer. Surveillance with MRI is effective in downstaging breast cancers, but the association of MRI surveillance with mortality risk has not been well defined. ObjectiveTo compare breast cancer mortality rates in women with a BRCA1 or BRCA2 sequence variation who entered an MRI surveillance program with those who did not. Design, Setting, and ParticipantsWomen with a BRCA1 or BRCA2 sequence variation were identified from 59 participating centers in 11 countries. Participants completed a baseline questionnaire between 1995 and 2015 and a follow-up questionnaire every 2 years to document screening histories, incident cancers, and vital status. Women who had breast cancer, a screening MRI examination, or bilateral mastectomy prior to enrollment were excluded. Participants were followed up from age 30 years (or the date of the baseline questionnaire, whichever was later) until age 75 years, the last follow-up, or death from breast cancer. Data were analyzed from January 1 to July 31, 2023. ExposuresEntrance into an MRI surveillance program. Main Outcomes and MeasuresCox proportional hazards modeling was used to estimate the hazard ratios (HRs) and 95% CIs for breast cancer mortality associated with MRI surveillance compared with no MRI surveillance using a time-dependent analysis. ResultsA total of 2488 women (mean [range] age at study entry 41.2 [30-69] years), with a sequence variation in the BRCA1 (n = 2004) or BRCA2 (n = 484) genes were included in the analysis. Of these participants, 1756 (70.6%) had at least 1 screening MRI examination and 732 women (29.4%) did not. After a mean follow-up of 9.2 years, 344 women (13.8%) developed breast cancer and 35 women (1.4%) died of breast cancer. The age-adjusted HRs for breast cancer mortality associated with entering an MRI surveillance program were 0.20 (95% CI, 0.10-0.43; P < .001) for women with BRCA1 sequence variations and 0.87 (95% CI, 0.10-17.25; P = .93) for women with BRCA2 sequence variations. Conclusion and RelevanceResults of this cohort study suggest that among women with a BRCA1 sequence variation, MRI surveillance was associated with a significant reduction in breast cancer mortality compared with no MRI surveillance. Further studies of women with BRCA2 sequence variations are needed to ascertain these women obtain the same benefits associated with MRI surveillance.
Filiaciones:
Lubinski, J:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Kotsopoulos, J:
Univ Toronto, Womens Coll Res Inst, Toronto, ON, Canada
Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
Moller, P:
Oslo Univ Hosp, Norwegian Radium Hosp, Inst Canc Res, Dept Tumour Biol, Oslo, Norway
Pal, T:
Vanderbilt Univ, Med Ctr, Vanderbilt Ingram Canc Ctr, Nashville, TN USA
Eisen, A:
Univ Toronto, Odette Canc Ctr, Dept Med Oncol, Toronto, ON, Canada
Peck, L:
Princess Margaret Canc Ctr, Bhalwani Familial Canc Clin, Toronto, ON, Canada
Karlan, BY:
Univ Calif Los Angeles, David Geffen Sch Med, Dept Obstet & Gynecol, Los Angeles, CA USA
Aeilts, A:
Ohio State Univ, Comprehens Canc Ctr, Div Human Genet, Med Ctr, Columbus, OH USA
Eng, C:
Cleveland Clin, Genom Med Inst, Ctr Personalized Genet Healthcare, Cleveland, OH USA
Bordeleau, L:
Juravinski Canc Ctr, Dept Oncol, Hamilton, ON, Canada
Foulkes, WD:
McGill Univ, Dept Oncol, McGill Program Canc Genet, Montreal, PQ, Canada
Tung, N:
Beth Israel Deaconess Med Ctr, Canc Risk & Prevent Program, Boston, MA USA
Couch, FJ:
Mayo Clin, Dept Lab Med & Pathol, Div Expt Pathol & Lab Med, Rochester, MN USA
Fruscio, R:
Univ Milano Bicocca, Dept Med & Surg, IRCCS San Gerardo, Monza, Italy
Cajal, T:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Singer, CF:
Med Univ Vienna, Dept Obstet & Gynecol, Vienna, Austria
Med Univ Vienna, Comprehens Canc Ctr, Vienna, Austria
Neuhausen, SL:
City Hope Natl Med Ctr, Div Biomarkers Early Detect & Prevent, Duarte, CA USA
Zakalik, D:
Beaumont Hosp, Canc Genet Program, Royal Oak, MI USA
Cybulski, C:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Gronwald, J:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Huzarski, T:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Stempa, K:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Dungan, J:
Northwestern Med Grp, Chicago, IL USA
Cullinane, C:
Long Beach Mem Ctr, Long Beach, CA USA
Olopade, OI:
Univ Chicago, Dept Med & Human Genet, Chicago, IL USA
Metcalfe, K:
Pomeranian Med Univ, Int Hereditary Canc Ctr, Dept Genet & Pathol, Szczecin, Poland
Univ Toronto, Bloomberg Sch Nursing, Toronto, ON, Canada
Sun, P:
Univ Toronto, Womens Coll Res Inst, Toronto, ON, Canada
Narod, SA:
Univ Toronto, Womens Coll Res Inst, Toronto, ON, Canada
Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
hybrid, Green Published
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