BRCA-Positive Women May Need More Mammograms

Genetically High-Risk Women May Need More Frequent Breast Cancer Screening

Medically Reviewed by Brunilda Nazario, MD on April 12, 2004
From the WebMD Archives

April 12 , 2004 -- Annual mammograms may not be enough for women who are genetically predisposed to breast cancer. A new study shows nearly half of the women with the BRCA genetic mutation developed breast cancer within six months of an annual mammogram.

Researchers say the findings show that more frequent breast cancer screening may be needed for women with the BRCA mutation than currently recommended.

Annual breast cancer screening with mammography is recommended for women over age 50, but there is no consensus regarding how frequently women with BRCA mutations should be screened for breast cancer. However, most guidelines do recommend starting screening in women with hereditary breast cancer five to 10 years before the age of the youngest affected relative.

Women with the BRCA1 or BRCA2 genetic mutation have a 60%-85% chance of developing breast cancer within their lifetime. Women who carry the gene are often informed about how they can lower their risk, such as close surveillance, preventive therapy using Tamoxifen, or prophylactic mastectomy surgery to remove breast tissue.

More Mammograms for BCRA Carriers

In the study, researchers reviewed the charts of 13 women with the BRCA genetic mutation who chose to follow close surveillance using annual screening by mammography or ultrasound, monthly breast self-exam, a clinical breast exam every 4-6 months, and consideration of breast MRI (magnetic resonance imaging).

The results appear in the April 12 online edition of the journal Cancer.

Three (23%) of the 13 women did not develop breast cancer. Four (31%) of the 13 women developed breast cancer that was detected at the time of the annual screening mammogram.

But six (46%) of the women developed breast cancers between their annual mammograms. The breast cancers were detected an average of about five months following their mammogram and the average size of the tumor was 1.7 centimeters. Four of these cancers were invasive and three had spread to the lymph nodes.

Researchers say the radiologists that had performed the mammograms on all six women who developed interval breast cancers had noted that the women had dense breast tissue that might have interfered with the accuracy of the results.

The study also showed that ultrasound imaging was able to detect the breast cancers in three of the four women who had developed breast cancer between screening intervals. None of the women underwent MRI breast imaging.

"These results suggest that strong consideration should be given to screening BRCA-positive women at more frequent intervals and to using additional imaging techniques, such as breast ultrasonography and/or breast MRI, as a part of this screening process," write researcher Ian K. Komenaka, MD, of Columbia-Presbyterian Medical Center in New York City, and colleagues.