%A Shraga,Shay
%A Grinshpun,Albert
%A Zick,Aviad
%A Kadouri,Luna
%A Cohen,Yogev
%A Maimon,Ofra
%A Adler-Levy,Yael
%A Zeltzer,Galina
%A Granit,Avital
%A Maly,Bella
%A Carmon,Einat
%A Meiner,Vardiella
%A Sella,Tamar
%A Hamburger,Tamar
%A Peretz,Tamar
%D 2021
%J Frontiers in Oncology
%C
%F
%G English
%K breast cancer,BRCA1/2,high-risk,Survival,screening
%Q
%R 10.3389/fonc.2021.683656
%W
%L
%M
%P
%7
%8 2021-September-02
%9 Original Research
%+ Albert Grinshpun,Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center,Israel,Albertg@hadassah.org.il
%+ Albert Grinshpun,Faculty of Medicine, The Hebrew University of Jerusalem,Israel,Albertg@hadassah.org.il
%#
%! Breast screening in BRCA1/2 Carriers Leads to Superior Outcomes
%*
%<
%T “High-Risk Breast Cancer Screening in BRCA1/2 Carriers Leads to Early Detection and Improved Survival After a Breast Cancer Diagnosis”
%U https://www.frontiersin.org/articles/10.3389/fonc.2021.683656
%V 11
%0 JOURNAL ARTICLE
%@ 2234-943X
%X BackgroundGermline BRCA1/2 pathogenic variant (PV) carriers have high lifetime risk of developing breast cancer and therefore subjected to intense lifetime screening. However, solid data on the effectiveness of high-risk screening of the BRCA1/2 carrier population is limited.Patients and MethodsRetrospectively, we analyzed 346 women diagnosed with breast tumors. Patients were divided according to the timing of BRCA1/2 PVrecognition, before (BRCA-preDx awareness, N = 62) or after (BRCA-postDx awareness group, N = 284) cancer diagnosis.ResultsMedian follow-up times were 131.42 and 93.77 months in the BRCA-preDx awareness and BRCA-postDx awareness groups, respectively. In the BRCA-preDx awareness group, 78.7% of the patients had invasive tumors and 21.3% were diagnosed with pure ductal carcinoma in situ. In contrast, in the BRCA-postDx awareness group over 93% of women were diagnosed with invasive cancer and only 6.4% had in situ disease. The mode of tumor detection differed significantly between the groups: 71.9% in the BRCA-postDx awareness group and 26.2% in the BRCA-preDx awareness group were diagnosed after personally palpating a lump. Tumor size and nodal involvement were significantly more favorable in the BRCA-preDx awareness group. T stage was significantly lower in the BRCA-preDx awareness group: 54.84% at T1 and 20.96% at Tis. In the BRCA-postDx awareness group, only 37.54% were at T1 and 6.49% at Tis. The N stage was also significantly lower in the BRCA-preDx awareness group: 71% had no lymph node metastases, compared with 56.1% in the BRCA-postDx awareness group. Additionally, therapeutic procedures varied between the groups: BRCA-preDx awareness group patients underwent more breast conserving surgeries. Axillary lymph node dissection was done in 38% of women in the BRCA-postDx awareness group and in only 8.7% of the BRCA-preDx awareness group patients. Interestingly, improved survival was found among patients who underwent high-risk screening (hazard ratio=0.34).ConclusionsHigh-risk screening might facilitate downstaging of detected breast tumor among BRCA1/2 carrier population.