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Background <p>The risk of developing breast cancer up to age 80 for women with <i>BRCA1/2</i> mutations is approximately 69–72%. The risk estimates, however, become labile in the later years of life. Many older <i>BRCA1/2</i> mutation carriers who have not developed breast cancer continue to undergo high-risk surveillance. We evaluated breast cancers in women age ≥ 70 and identified which modality diagnosed the malignancy.</p> Methods <p>Females with <i>BRCA1/2</i> mutations identified between 1996 and 2022 were included in this single institution retrospective review. The cohort was divided by age at <i>BRCA1/2</i> diagnosis (30–59, 60–69 &amp; ≥ 70). The number of malignancies and imaging modality which led to the diagnosis were recorded.</p> Results <p>There were 316 patients with <i>BRCA1/2</i> mutations: 266/316 (84.2%) were 30–59&#xa0;years old at the time of genetic testing, 35/316 (11.1%) were 60–69, and 15/316 (4.7%) were ≥ 70. Median follow-up was 57&#xa0;months (IQR 21.6–114.6). There were 178 (56.3%) breast malignancies diagnosed; 161/266 (60.5%) age 30–59, 11/35 (31.4%) ages 60–69, and 6/15 (40%) age ≥ 70 (p = 0.002). Of patients with a malignant diagnosis (n = 178), 140/178 (78.7%) had their cancers discovered on either screening or diagnostic mammogram, 30/178 (16.9%) by MRI, 1 /178 (0.6%) on ultrasound, and 1/178 (0.6%) was discovered on surgical pathology. Of the breast cancers diagnosed in patients age ≥ 70, 66.7% (4/6) were found on mammogram.</p> Conclusions <p>In women ≥ 70 with <i>BRCA1/2</i> mutations, mammograms may be sufficient surveillance. Given that a number of older <i>BRCA1/2</i> carriers may never develop breast cancer, our data supports individualized care and consideration for de-escalated surveillance in those ≥ 70.</p>

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High risk surveillance MRI may not be necessary in BRCA1/2 mutation carriers over 70 years old

  • 期刊论文

  • 发表日期：

    2025年2月27日

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  • Astrid Botty van den Bruele,
  • Yi Ren,
  • Samantha M. Thomas,
  • Koumani W. Ntowe,
  • Laura H. Rosenberger,
  • Carolyn Menendez,
  • Lars J. Grimm,
  • Akiko Chiba,
  • Jennifer K. Plichta

摘要

Background

The risk of developing breast cancer up to age 80 for women with BRCA1/2 mutations is approximately 69–72%. The risk estimates, however, become labile in the later years of life. Many older BRCA1/2 mutation carriers who have not developed breast cancer continue to undergo high-risk surveillance. We evaluated breast cancers in women age ≥ 70 and identified which modality diagnosed the malignancy.

Methods

Females with BRCA1/2 mutations identified between 1996 and 2022 were included in this single institution retrospective review. The cohort was divided by age at BRCA1/2 diagnosis (30–59, 60–69 & ≥ 70). The number of malignancies and imaging modality which led to the diagnosis were recorded.

Results

There were 316 patients with BRCA1/2 mutations: 266/316 (84.2%) were 30–59 years old at the time of genetic testing, 35/316 (11.1%) were 60–69, and 15/316 (4.7%) were ≥ 70. Median follow-up was 57 months (IQR 21.6–114.6). There were 178 (56.3%) breast malignancies diagnosed; 161/266 (60.5%) age 30–59, 11/35 (31.4%) ages 60–69, and 6/15 (40%) age ≥ 70 (p = 0.002). Of patients with a malignant diagnosis (n = 178), 140/178 (78.7%) had their cancers discovered on either screening or diagnostic mammogram, 30/178 (16.9%) by MRI, 1 /178 (0.6%) on ultrasound, and 1/178 (0.6%) was discovered on surgical pathology. Of the breast cancers diagnosed in patients age ≥ 70, 66.7% (4/6) were found on mammogram.

Conclusions

In women ≥ 70 with BRCA1/2 mutations, mammograms may be sufficient surveillance. Given that a number of older BRCA1/2 carriers may never develop breast cancer, our data supports individualized care and consideration for de-escalated surveillance in those ≥ 70.