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Study: MRI or mammograms for detecting breast cancer in families with unknown genetic mutations?

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Contents

At a glance                  Questions for your doctor
Findings               In-depth                
Clinical trials Limitations
Guidelines Resources


STUDY AT A GLANCE

This study is about:

whether or mammograms are better at detecting cancers in women with a family history of breast cancer but no known genetic mutation.


Why is this study important?

Prior studies show that plus is more effective than alone for detecting breast cancer in high-risk women. The FaMRisC study is the first to compare breast and mammograms for breast cancer detection in women with a family history of breast cancer.


Study findings

  • detected 24 (4%) invasive breast cancers compared to alone, which discovered 8 cancers (1%).
     
  • The breast cancers detected in the group were smaller, of early and less often involved than the breast cancers detected among the group. The researchers concluded that detected breast cancers at earlier stages than .
     
  • There were more false positives (suspected cancer that was disproven by biopsy) with (449) than with (276) as expected from prior studies.
     
  • detected more breast cancers in women in all breast density groups except the very dense breast tissue group. Among women with very dense breast tissue, similar numbers of breast cancer were detected by and (5 and 6 cases respectively).
     
  • The rate of false positives increased with breast tissue density with both and . Overall there more false positives were identified with than with among all breast densities.
     
  • The researchers concluded that detected breast cancers at earlier stages than mammograms.

What does this mean for me?

If you have a family history of breast cancer and you do not have a mutation in a gene associated with breast cancer (e.g. , , , , , , , , , , or genes), you may still benefit from breast cancer screening by . appears to detect breast cancers at earlier stages, at smaller sizes, and more frequently before node involvement occurs. You may have more results with . The expectation is that this early detection may improve outcomes, as expected from related studies, although the data from this study is still incomplete.

Posted 8/15/19

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Reference

Saadatmand S, Geuzinge A, Rutgers JT, et al., " versus for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial." The Lancet. August 1, 2019; 20(8):1136-1147.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

People with a personal or family history of cancer where no mutation has been found

This article is also relevant for:

Previvors

People with a genetic mutation linked to cancer risk

Women under 45

Women over 45

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IN-DEPTH REVIEW OF RESEARCH

Study background:

Fifteen percent of all women with breast cancer have a family history of the disease but have no known mutation associated with increased breast cancer risk. Several trials that looked at adding to as a screening method showed that breast cancer cases were detected earlier than with alone. However, these were not trials and was done at the same time as . Additionally, these trials did not determine how breast density affected results.

Current NCCN guidelines in the United States recommend annual and clinical breast exam with for women 30 or older who have a lifetime risk of breast cancer of 20% or more. However, in other countries these recommendations vary. In the Netherlands and U.K., is only recommended for women with or mutations.  For this study, researchers want to know how compares to at detecting breast cancer for women with familial breast cancer.


Researchers of this study wanted to know:

whether or  are better at detecting cancer in women with a family history of breast cancer but without a known genetic mutation.


Populations looked at in this study:

This trial enrolled 1,355 women from 12 outpatient breast cancer clinics or family cancer clinics from 7 academic medical centers in the Netherlands between Jan 1, 2011 and Dec 31 2017. Participants were 30-55 years of age with a lifetime risk of breast cancer of 20% or higher based on family history. Women with a known inherited mutation in , or were excluded because surveillance is already recommended for them. Women with previously diagnosed invasive breast cancer were also excluded. One woman in the group was diagnosed with an invasive breast cancer after randomization and before initial screening and was excluded. After randomization, the total number of participants was 1,354: 674 in the group and 680 in the group.

Women who did not consent to randomization of screening methods were registered, screened by their chosen method and their results were included in analysis of screening method among groups with different breast densities. There were 13 women in the registration group and 218 in the registration group. Combining the and registry groups, there were 206 women with category A breast density (fatty, not dense), 549 women with category B breast density (scattered density), 562 women with category C breast density (heterogeneously dense), and 239 women with category D breast density (extremely dense).


Study design:

Participants were to one of two groups:

  • The group received annual MRIs and clinical breast exams and had screening every other year.
  • The group received annual testing and clinical breast exams.

The average number of screening rounds was 4.3 screenings per person. Participants were followed for an average of 5.2 years after joining the study.


Study findings: 

A total of 55 breast cancers were detected (32 invasive cancer cases and 23 ductal carcinoma in situ () cases). None of the breast cancers were and none had metastasized.

  • More breast cancers were detected in the group than the group.
     
    • In the group, 24 invasive cancers (4%) and 16 (2%) were detected.
      • Overall, in the group, 14.2 breast cancers were detected for every 1,000 rounds of screening.
    • In the group, 8 invasive cancers (1%) and 7 cases of (1%) were detected.
      • Overall, in the group, 4.9 breast cancers were detected for every 1,000 rounds of screening.
         
  • The breast cancers detected in the group were smaller, of earlier , and less often involved than breast cancers detected among the group. Researchers concluded that detected breast cancers at earlier stages than .
     
    • In the group, the median size of the invasive breast cancers was 9 mm.
    • In the group, the median size of the invasive breast cancers was 17 mm.
       
    • In the group, the majority of invasive breast cancer were T1a (larger than 1 mm and up to 5 mm) or T1b (larger than 5 mm and up to 10 mm).
      • 14 of 24 invasive breast cancers (58%) were T1a or T1b.
      • 10 of 24 invasive breast cancer (42%) were T1C (larger than 10 mm and up to 22 mm), T2 (larger than 20 mm and up to 50 mm) or T3 (larger than 50 mm).
         
    • In the group, the majority of invasive breast cancers were more advanced than T1b:
      • 1 of 8 invasive breast cancers (13%) were T1a or T1b.
      • 7 of 8 invasive breast cancer (87%) were T1c or T2.
         
    • In the group, the majority of invasive breast cancers did not involve lymph nodes:
      • 4 of 24 invasive breast cancers (17%) were node positive.
    • In the group, the majority of invasive breast cancers involved lymph nodes:
      • 5 of 8 invasive breast cancers (63%) were node positive.
         
  • As expected, produced more false positives (suspected cancer that was disproven by biopsy) than mammography:
     
    • 449 false positives results occurred in the group.
      • 275 of 449 (61%) false positives were detected by only.
      • 19 of 449 ( 4%) false positives were detected by both and .
      • 98 of 449 (22%) false positives were detected by (from every other year).
      • 57 of 449 (13%) false positives were detected by clinical exam.
         
    • 276 results occurred in the group.
      • 157 of 276 (57%) false positives were detected by only.
      • 9 of 276 (3%) false positives were detected by .
      • 10 of 276 (40%) false positives were detected by clinical exam.
         
  • detected more breast cancer in women among all breast density groups except the very dense breast tissue group. Among women with very dense breast tissue, similar numbers of breast cancer were detected in both the and groups (5 and 6 cases respectively).
     
    • Among women with category A (fatty, least dense)
      • In the group, breast cancer was detected in 5 of 86 (6%) women.
      • In the group, no breast cancer was detected among the 120 (0%) women.
         
    • Among women with category B (scattered density)
      • In the group, 15 of 249 (6%) women had a breast cancer detected.
      • In the group, 7 of 300 (2%) women had a breast cancer detected.
         
    • Among women with category C (heterogeneously dense)
      • In the group, 17 of 238 (7%) women had breast cancers detected
      • In the group, 10 of 324 (3%) women had a breast cancer detected.
         
    • Among women with category D (extremely dense)
      • In the group, 5 of 105 (5%) women had breast cancers detected.
      • In the group, 6 of 134 (4%) women had a breast cancer detected.
         
  • The rate of false positives increased with breast tissue density with both and . Overall, produced more false positives than among all breast densities.
     
    • Among women with category A (fatty, least dense)
      • In the group, 38 of 86 (44%) had results.
      • In the group, 37 of 120 (31%) women had results.
         
    • Among women with category B (scattered density)
      • In the group, 150 of 249 (60%) women had results.
      • In the group, 96 of 300 (32%) women had results.
         
    • Among women with category C (heterogeneously dense)
      • In the group, 164 of 238 (69%) women had results.
      • In the group, 157 of 324 (48%) women had results.
         
    • Among women with category D (extremely dense)
      • In the group, 100 of 105 (95 %) women had results.
      • In the group, 79 of 134 (59%) women had results.

Limitations:

A clear limitation of as a screening method is the frequency of results. These results require further testing and biopsies to rule out an invasive cancer diagnosis. On the other hand, the rate of detecting earlier, node negative cancers suggest that screening may lead to improved outcomes in terms of mortality. The researchers note that they intend to follow up with mortality data in the future.

Another potential problem is that uses a gadolinium tracer, which carries a small chance of very small amounts being retained in brain tissue. This is not known to cause harmful effects.

was better at detecting cancers in most breast tissue (groups A-C) than . Contrary to the researchers’ expectation, was not significantly different from at detecting breast cancers in the group of women with the most dense breast tissue. Similar numbers of cancers were detected by both methods, suggesting that neither method is better or worse than the other. The numbers of breast cancers in each breast density group were small, which may have limited the ability to observe small differences. Additionally, compared to , produced far more false positives among women with extremely dense breasts. This may limit its usefulness among this population.


Conclusions:

The researchers concluded that detected breast cancers at earlier stages than and at all but the most extreme breast densities. One drawback is that screening led to more false positives than . Overall, may improve detection for high-risk women who do not have known genetic mutations.

Share your thoughts on this XRAYS article by taking our brief survey.

Posted 8/15/19

Expert Guidelines Expert Guidelines

The National Comprehensive Cancer Network (NCCN) establishes guidelines for women with increased risk (a lifetime risk for breast cancer of 20 percent or more). The guidelines recommend the following screening:

  • Have clinical exams every 6–12 months, starting when you are identified as being at increased risk, but not before age 21.
  • Consider consulting with a genetic counselor or similarly trained health care provider, if you haven’t already done so.
  • Consider consulting with a breast surgeon.
  • Start annual screening at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 30. Consider getting a 3-D .
  • Begin annual breast at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 25.
  • Consider recommended risk reduction strategies, such as preventive hormonal medications.
  • Develop breast awareness and report any changes to your health care providers.

NCCN has separate guidelines for breast screening in women with an inherited mutation. See our gene-by-gene listing to find specific risk-management guidelines for people with an inherited mutation linked to cancer.  

Updated: 03/28/2022

Questions to Ask Questions to Ask Your Doctor

  • What method of screening or combination of methods do you recommend given my personal and family history?
  • What are the benefits and risks of screening by and by ?
  • What follow-up would you recommend if my breast comes back with an abnormal finding?
  • How often should I be screened for breast cancer?
  • Will my insurance cover breast cancer screening?

 

Open Clinical Trials Open Clinical Trials

The following breast cancer screening clinical trials are currently enrolling participants:

Open Clinical Trials Open Clinical Trials

The following are breast cancer screening or prevention studies enrolling people at high risk for breast cancer.   

Additional risk-management clinical trials for people at high risk for breast cancer may be found here.

Updated: 06/29/2022

Peer Support Peer Support

The following organizations offer peer support services for people with, or at high risk for breast cancer:

Updated: 02/25/2022

Who covered this study?

MedPage Today

MRI Wins Again in Women at High Risk for Breast Cancer This article rates 5.0 out of 5 stars

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