Tilanus-Linthorst Madeleine M A, Obdeijn Inge-Marie, Hop Wim C J, Causer Petrina A, Leach Martin O, Warner Ellen, Pointon Linda, Hill Kimberley, Klijn Jan G M, Warren Ruth M L, Gilbert Fiona J
Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Clin Cancer Res. 2007 Dec 15;13(24):7357-62. doi: 10.1158/1078-0432.CCR-07-0689.
Magnetic resonance imaging (MRI) screening enables early detection of breast cancers in women with an inherited predisposition. Interval cancers occurred in women with a BRCA1 mutation, possibly due to fast tumor growth. We investigated the effect of a BRCA1 or BRCA2 mutation and age on the growth rate of breast cancers, as this may influence the optimal screening frequency.
We reviewed the invasive cancers from the United Kingdom, Dutch, and Canadian MRI screening trials for women at hereditary risk, measuring tumor size at diagnosis and on preceding MRI and/or mammography. We could assess tumor volume doubling time (DT) in 100 cancers.
Tumor DT was estimated for 43 women with a BRCA1 mutation, 16 women with a BRCA2 mutation, and 41 women at high risk without an identified mutation. Growth rate slowed continuously with increasing age (P = 0.004). Growth was twice as fast in BRCA1 (P = 0.003) or BRCA2 (P = 0.03) patients as in high-risk patients of the same age. The mean DT for women with BRCA1/2 mutations diagnosed at ages < or =40, 41 to 50, and >50 years was 28, 68, and 81 days, respectively, and 83, 121, and 173 days, respectively, in the high-risk group. Pathologic tumor size decreased with increasing age (P = 0.001). Median size was 15 mm for patients ages < or =40 years compared with 9 mm in older patients (P = 0.003); tumors were largest in young women with BRCA1 mutations.
Tumors grow quickly in women with BRCA1 mutations and in young women. Age and risk group should be taken into account in screening protocols.
磁共振成像（MRI）筛查能够早期发现具有遗传易感性的女性乳腺癌。BRCA1突变的女性会出现间期癌，这可能是由于肿瘤生长迅速所致。我们研究了BRCA1或BRCA2突变以及年龄对乳腺癌生长速率的影响，因为这可能会影响最佳筛查频率。
我们回顾了英国、荷兰和加拿大针对有遗传风险女性的MRI筛查试验中的浸润性癌，在诊断时以及之前的MRI和/或乳腺钼靶检查时测量肿瘤大小。我们能够评估100例癌症的肿瘤体积倍增时间（DT）。
对43例BRCA1突变女性、16例BRCA2突变女性和41例未发现突变的高危女性的肿瘤DT进行了估计。随着年龄增长，生长速率持续减慢（P = 0.004）。BRCA1（P = 0.003）或BRCA2（P = 0.03）患者的生长速度是同年龄高危患者的两倍。年龄≤40岁、41至50岁以及＞50岁的BRCA1/2突变女性的平均DT分别为28天、68天和81天，高危组分别为83天、121天和173天。病理肿瘤大小随年龄增长而减小（P = 0.001）。年龄≤40岁患者的肿瘤中位数大小为15 mm，而年龄较大患者为9 mm（P = 0.003）；BRCA1突变的年轻女性肿瘤最大。
BRCA1突变女性和年轻女性的肿瘤生长迅速。在筛查方案中应考虑年龄和风险组。
