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Effective Surveillance of High-Risk Women

      Abstract

      Background

      This study addresses the effectiveness of risk models and screening breast magnetic resonance imaging (MRI) in women who have atypical hyperplasia (AH), lobular carcinoma in situ (LCIS), or a family history of breast cancer, but not a genetic mutation.

      Patients and Methods

      A retrospective review of 444 women who had 458 breast screening MRIs at a community teaching hospital over a 12-month period between March 25, 2014 and March 31, 2015 was performed. The patients underwent high risk screening with breast MRIs alternating with mammograms every 6 months. After excluding patients with prior breast or ovarian cancer, genetic mutations, and chest wall radiation, 200 remaining patients constituted the study cohort. Over the following 5 years, the patients were screened with MRIs alternating with mammograms every 6 months. A total of 961 total MRI screenings were performed over the entire 5-year period of the study.

      Results

      A total of 200 women fit the study criteria. Of these 103 had a prior history of AH or LCIS. Over the 5-year period, 60 women dropped out of the screening regimen, 6 patients were diagnosed with breast cancer on screening MRIs, and 2 additional patients were diagnosed with breast cancer on screening mammograms. Surprisingly, the highest Tyrer-Cuzick (T-C) scores did not correlate with increased development of breast cancers in our population.

      Conclusions

      This study shows that there is wide variation in the results of risk assessment models. Risk models may overestimate breast cancer risk, suggesting that re-evaluation of current risk assessment and screening protocols is warranted.

      Keywords

      Abbreviations:

      BRCA (BReast CAncer gene), MRI (magnetic resonance imaging), ACS (American Cancer Society), BRCAPro (Mathematical tool to predict probability of carrying BRCA gene mutation), AH (Atypical hyperplasia), LCIS (Lobular carcinoma in situ), T-C (Tyrer-Cuzick), T-C v7 (Tyrer-Cuzick version 7), CRA (Comprehensive risk assessment), DCIS (Ductal carcinoma in situ), FDA (Food and Drug Administration), GBCA (gadolinium-based contrast agents), PPV (Positive predictive value), BMI (Body mass index), BIRADS (Breast Imaging-Reporting and Data System), IRB (Institutional Review Board)
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