Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Breast J. 2021 May;27(5):423-431. doi: 10.1111/tbj.14185. Epub 2021 Feb 7.
The Ontario Breast Screening Program was expanded in 2011 to offer annual MRI and mammography to women with high-risk genetic mutations (e.g., BRCA1/2) and women with strong family histories and ≥25% estimated lifetime risk of breast cancer. Data to support high-risk screening is less clear in the nonmutation carrier group, as MRI has lower specificity among this population. The potential unintended consequences may be considerable and need to be explored. We aimed to describe the frequency of abnormal screens and biopsies.
Demographic surveys and chart review consent were sent to a sample of 441 individuals enrolled in a high-risk screening program at two tertiary care hospitals in Toronto, Ontario. Retrospective cross-sectional chart review was undertaken for clinicopathologic data. The frequencies of abnormal screens and biopsies were calculated.
One hundred sixty-nine nonmutation carriers were included. The majority were white, employed, and highly educated. The median International Breast Cancer Intervention Study lifetime risk of breast cancer was 28.0% (range 24.5%-89.0%). 108 individuals (64%) experienced at least 1 abnormal screen and 13 (8%) had 3 or more over a median 3 years of screening (range 1-6 years). Of 55 biopsies, 3 (5.5%) were malignant. The cancer detection rate was 8.4/1000 screens (95% CI 3.2-22.4).
An MRI-based screening program for nonmutation carriers was effective at diagnosing breast cancer. However, this population experienced a high rate of abnormal screens and intervention. Further research is needed to improve the performance of MRI-based screening in these women.
安大略省乳房筛查计划于 2011 年扩大，为携带高风险基因突变（如 BRCA1/2）的女性以及有强烈家族史和估计终生乳腺癌风险≥25%的女性提供每年一次的 MRI 和乳房 X 光检查。在非突变携带者群体中，MRI 的特异性较低，因此支持高危筛查的数据不太明确。这种情况可能会产生相当大的潜在负面影响，需要进行探讨。我们旨在描述异常筛查和活检的频率。
向安大略省多伦多的两家三级保健医院参加高危筛查计划的 441 名个体的样本发送了人口统计学调查和图表审查同意书。对临床病理数据进行了回顾性横断面图表审查。计算了异常筛查和活检的频率。
纳入了 169 名非突变携带者。大多数为白人、有工作和受过高等教育。国际乳腺癌干预研究的终生乳腺癌风险中位数为 28.0%（范围 24.5%-89.0%）。108 名个体（64%）至少经历了一次异常筛查，13 名（8%）在中位 3 年的筛查期间（范围 1-6 年）经历了 3 次或更多次。55 次活检中有 3 次（5.5%）为恶性。癌症检出率为 8.4/1000 次筛查（95%CI 3.2-22.4）。
针对非突变携带者的基于 MRI 的筛查计划在诊断乳腺癌方面有效。然而，该人群的异常筛查和干预率较高。需要进一步研究以提高 MRI 筛查在这些女性中的性能。
