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Do Breast Cancers Appear Different in Different Risk Groups?

March 9, 2008
Written by: , Filed in: Breast Imaging
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The objective of a recent study was to evaluate mammographic, sonographic, and MRI findings in women with familial breast cancers.

The study has concluded that imaging features of breast cancers vary among different risk groups.

Design/Participants
This prospective study included 629 women with known familial breast cancers or family history highly suggestive of breast cancers.

Methodology
Participants were divided into 3 groups: (1) women with proven mutation in BRCA1 or BRCA2; (2) a moderate-risk group without proven mutation; or (3) a high-risk group without proven mutation. Results of annual mammograms, ultrasounds, MRIs, and biannual clinical breast examinations performed in the 10-year period were reviewed.

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Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast

Results of the Study
76 cancers were diagnosed; 84% were invasive type, and invasive ductal carcinoma was the most common histologic type. No significant difference was seen in staging or histology among different risk groups. Almost half of all invasive cancers did not have positive mammographic correlates.

The most common mammographic manifestations of invasive cancers were irregular masses without associated calcium deposits. However, 11% of invasive cancers had benign-appearing mass-like findings on mammograms.

The false-negative rate of mammograms was not affected by the different breast density patterns. Only 62% of invasive cancers had positive findings on ultrasonography. Among these, 35% had sonographic features that were suggestive of benign masses, not malignancy. On MRI, 98% of all cancers had positive findings, which consisted of 78% enhancing masses and 21% non-mass-like enhancement.

Overall, 23% of invasive cancers showed benign morphologies with suspicious kinetics, and 19% of invasive cancers showed suspicious morphologies with benign kinetic pattern.

Only 33% of cases of pure ductal carcinoma in situ (DCIS) were detected on mammography. Ultrasonography detected none of the pure DCIS. MRI detected 92% of all pure DCIS. More than half the cancers occurred in the upper outer quadrants, in the posterior aspect of the breast, and often near the pectoralis areas. DCIS or malignant calcium deposits were not diagnosed among BRCA1 mutation carriers.

Conclusions
Imaging features of breast cancers vary among different risk groups. MRI offers the highest sensitivity for screening high-risk women when morphologic and kinetic criteria are used together.

Reviewer’s Comments
Women who are BRCA1 and BRCA2 mutation carriers and those with strong family histories of multiple perimenopausal first-degree relatives with breast cancers or ovarian cancers are at increased risk for high-grade breast cancers, which often have fibro adenoma-like morphologies at young ages.

Also, it has been suggested that annual mammography alone is not adequate for screening this population. The authors have suggested that mammography offers very limited benefits for BRCA1 mutation carriers. However, MRI offers 96% sensitivity for these women. The authors suggested the following screening protocols for different risk groups:

  • for BRCA1 mutation carriers, annual screening MRI with or without ultrasonography instead of annual screening mammography;
  • and for BRCA2 mutation carriers and other risk groups, annual mammography along with annual MRI.

Author: Bokran Won, MD

Reference
Schrading S, Kuhl CK. Mammographic, US, and MR Imaging Phenotypes of Familial Breast Cancer. Radiology; 2008; 246 (January): 58-70:

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Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast
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