Warner Ellen, Zhu Siqi, Plewes Donald B, Hill Kimberley, Ramsay Elizabeth A, Causer Petrina A, Seely Jean, Jong Roberta A, Lenkov Pamela, Elser Christine, Crystal Pavel, Yaffe Martin J, Giannakeas Vasily, Sun Ping, Narod Steven A
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada.
Cancers (Basel). 2020 Nov 23;12(11):3479. doi: 10.3390/cancers12113479.
Annual breast magnetic resonance imaging (MRI) plus mammography is the standard of care for screening women with inherited mutations. However, long-term breast cancer-related mortality with screening is unknown. Between 1997 and June 2011, 489 previously unaffected mutation carriers aged 25 to 65 years were screened with annual MRI plus mammography on our study. Thereafter, participants were eligible to continue MRI screening through the high-risk Ontario Breast Screening Program. In 2019, our data were linked to the Ontario Cancer Registry of Cancer Care Ontario to identify all incident cancers, vital status and causes of death. Observed breast cancer mortality was compared to expected mortality for age-matched women in the general population. There were 91 women diagnosed with breast cancer (72 invasive and 19 ductal carcinoma in situ (DCIS)) with median follow-up 7.4 (range: 0.1 to 19.2) years. Four deaths from breast cancer were observed, compared to 2.0 deaths expected (standardized mortality ratio (SMR) 2.0, = 0.14). For the 489 women in the study, the probability of not dying of breast cancer at 20 years from the date of the first MRI was 98.2%. Annual screening with MRI plus mammography is a reasonable option for women who decline or defer risk-reducing mastectomy.
每年进行乳腺磁共振成像（MRI）检查加乳房X光检查是对携带遗传性突变的女性进行筛查的标准护理方法。然而，筛查与长期乳腺癌相关的死亡率尚不清楚。1997年至2011年6月期间，我们对489名年龄在25至65岁之间、此前未受影响的突变携带者进行了每年一次的MRI检查加乳房X光检查。此后，参与者有资格通过安大略省高危乳腺筛查项目继续进行MRI筛查。2019年，我们的数据与安大略省癌症护理中心的安大略癌症登记处相关联，以确定所有新发癌症、生命状态和死亡原因。将观察到的乳腺癌死亡率与普通人群中年龄匹配女性的预期死亡率进行比较。有91名女性被诊断为乳腺癌（72例浸润性癌和19例导管原位癌（DCIS）），中位随访时间为7.4年（范围：0.1至19.2年）。观察到4例死于乳腺癌，而预期死亡2.0例（标准化死亡率（SMR）为2.0，P = 0.14）。对于研究中的489名女性，从首次MRI检查之日起20年内不死于乳腺癌的概率为98.2%。对于拒绝或推迟进行降低风险乳房切除术的女性，每年进行MRI检查加乳房X光检查是一个合理的选择。
