Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Ann Surg Oncol. 2024 Oct;31(10):6764-6773. doi: 10.1245/s10434-024-15633-x. Epub 2024 Jun 29.
High-risk programs provide recommendations for surveillance/risk reduction for women at elevated risk for breast cancer development. This study evaluated the impact of high-risk surveillance program participation on clinicopathologic breast cancer features at the time of diagnosis.
Women followed in the authors' high-risk program (high-risk cohort [HRC]) with a diagnosis of breast cancer from January 2015 to June 2021 were identified and compared with the general population of women undergoing breast cancer surgery at Memorial Sloan Kettering Cancer Center (MSK; general cohort [GC]) during the same period. Patient and tumor factors were collected. Clinicopathologic features were compared between the two cohorts and in a subset of women with a family history of known BRCA mutation.
The study compared 255 women in the HRC with 9342 women in the GC. The HRC patients were slightly older and more likely to be white and have family history than the GC patients. The HRC patients also were more likely to present with DCIS (41 % vs 23 %; p < 0.001), to have smaller invasive tumors (pT1: 100 % vs 77 %; p < 0.001), and to be pN0 (95 % vs 81 %; p < 0.001). The HRC patients had more invasive triple-negative tumors (p = 0.01) and underwent less axillary surgery (p < 0.001), systemic therapy (p < 0.001), and radiotherapy (p = 0.002). Among those with a known BRCA mutation, significantly more women in the HRC underwent screening mammography (75 % vs 40 %; p < 0.001) or magnetic resonance imaging (MRI: 82 % vs 9.9 %; p < 0.001) in the 12 months before diagnosis.
Women followed in a high-risk screening program have disease diagnosed at an earlier stage and therefore require less-intensive breast cancer treatment than women presenting to a cancer center at the time of diagnosis. Identification of high-risk women and implementation of increased surveillance protocols are vital to improving outcomes.
高风险方案为罹患乳腺癌风险较高的女性提供了监测/降低风险的建议。本研究评估了参加高风险监测方案对诊断时临床病理乳腺癌特征的影响。
从 2015 年 1 月至 2021 年 6 月，作者所在的高风险项目（高风险队列 [HRC]）中诊断出患有乳腺癌的女性，并与同期在纪念斯隆凯特琳癌症中心（MSK；一般人群队列 [GC]）接受乳腺癌手术的女性进行比较。收集了患者和肿瘤因素。比较了两个队列的临床病理特征，并在一组有已知 BRCA 突变家族史的女性中进行了比较。
本研究比较了 255 例 HRC 患者和 9342 例 GC 患者。HRC 患者年龄稍大，白人及有家族史的比例高于 GC 患者。HRC 患者也更有可能表现为 DCIS（41%比 23%；p < 0.001），侵袭性肿瘤较小（pT1：100%比 77%；p < 0.001），且 pN0（95%比 81%；p < 0.001）。HRC 患者有更多的侵袭性三阴性肿瘤（p = 0.01），接受的腋窝手术（p < 0.001）、全身治疗（p < 0.001）和放疗（p = 0.002）较少。在已知有 BRCA 突变的患者中，HRC 中有显著更多的女性在诊断前 12 个月内接受了筛查性乳房 X 线摄影（75%比 40%；p < 0.001）或磁共振成像（MRI：82%比 9.9%；p < 0.001）。
在高风险筛查项目中接受随访的女性在疾病诊断时处于更早的阶段，因此需要比在癌症中心就诊的女性更少的强化乳腺癌治疗。识别高风险女性并实施更多的监测方案对于改善结局至关重要。
