Breast cancer screening in women at high risk of hereditary breast cancer: an Australian experience.

BACKGROUND: While population-based breast screening is a well-documented health strategy worldwide, very few centres offer breast-screening programmes specifically targeted at women at high risk of hereditary breast cancer. We present our experience with multimodality breast screening in a high-risk population. METHODS: The outcomes from a familial breast cancer clinic at the North Brisbane BreastScreen Queensland Service providing a multimodality screening programme for high-risk women were reviewed from the prospectively maintained database between 2011 and 2018. RESULTS: Over the 8 years of study period, a total of 6686 annual screening rounds were performed for 823 asymptomatic women at high risk of hereditary breast cancer. As a result, 40 cancers were diagnosed including 25 invasive ductal cancers, three invasive lobular cancers, two invasive cancers with mixed ductal and lobular features and 10 ductal carcinomas in situ. Ultrasound and mammography detected 72.5% (29/40) and 55% (22/40) of the cancers, respectively. A total of 3672 magnetic resonance imaging studies were performed. Ten (25%) cancers were initially only seen on magnetic resonance imaging including seven invasive ductal cancers, one invasive lobular cancer and two high-grade ductal carcinomas in situ. The cancer detection rate for first-round screening was 13.3 cancers per 1000 women screened, with 4.9 cancers per 1000 women detected on subsequent-round screening. One interval cancer occurred in the study period. CONCLUSION: Multimodality breast screening of younger women at high risk of hereditary breast cancer is effective with the yield substantially exceeding the results from established breast screening programmes in older women. Co-location of this service within BreastScreen Australia efficiently shares resources.

Outcomes of multimodality breast screening for women at increased risk of familial breast cancer.

BACKGROUND: While population-based breast screening for women over the age of 50 years is a generally accepted and proven health strategy, the role of breast screening specifically among women at high risk of familial breast cancer has remained controversial. Indeed, there are very few services specifically offering a breast-screening program for women at high risk of familial breast cancer. METHODS: In 1999 a Familial Breast Cancer Screening Clinic (FBCSC) was established at the North Brisbane BreastScreen Queensland Service to provide a regular multimodality screening program utilizing clinical breast examination, breast ultrasound, and mammography for women at higher risk of hereditary breast cancer and with entry into the program commencing from the age of 30 years. RESULTS: Since its inception, a total of 2440 women have participated in the FBCSC. A total 7051 breast-screening examinations have been performed on these participants, with 53 breast cancers being diagnosed, including 8 in situ ductal carcinomas, 38 invasive ductal carcinomas, and 7 invasive lobular carcinomas. The mean size of the cancers was 16 mm (range = 1-45 mm), and of the 45 invasive cancers, 60% were less than or equal to 15 mm in size. The overall axillary node positive rate was 24.5% (13/53). The invasive cancer detection rate for first-round screening was 8.3 cancers per 1000 women screened, with 5.2 cancers per 1000 women detected on subsequent round screening. CONCLUSIONS: The results from this service demonstrate that multimodality screening for women at high risk of familial breast cancer and including women of younger age is effective and appropriate, with very acceptable cancer detection rates and pathological cancer characteristics being observed consistent with early-stage detection. The colocated siting of this service within a BreastScreen Queensland facility has proven to be efficient and cost effective.