An analysis of breast-cancer screening in high risk women.

Bruijn, S. de (Simone) (2015) An analysis of breast-cancer screening in high risk women. thesis, Medicine.

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Abstract

Introduction In the United Kingdom, guidelines for breast cancer screening for carriers of the BRCA1/2 mutation recommends to postpone the age at which mammographic screening is initiated, additionally to the MRI screening from the age 30 to age 40(1,2). This is different for the Netherlands as here screening with mammography in women with a BRCA1/2 mutation is started at the age of 30. The main reason in the United Kingdom for postponing this age is to minimize the induced radiation risk by mammography in women with the BRCA gene mutation and since the specificity of mammograms in young women is relatively low, this may lead to unnecessary diagnostics. To investigate this, the research questions of this research are: 1. How do tumour characteristics such as tumour morphology type, size and grade differ in BRCA1 and BRCA2 mutation carriers? 2. Can the age of screening with mammography in women with the BRCA1/2 mutation be postponed from 30 to 40? Method To answer the research questions high-risk women with either the BRCA1 or BRCA2 mutation and who were diagnosed with any type of breast cancer between the age 30 and 40 were included. Three types of data (basic patient information, tumour characteristics and screening images) were collected from the HEBON database as well as from electronic patient files from the hospitals. Later on radiologists will to see if tumours would have been missed if mammography were not performed. Data analysis was done using Chi-square tests and a linear regression model in SPSS to compare the two BRCA mutations. Results and conclusion Our database consisted of 526 women and 597 breast cancer cases. Of this data 60 women and 69 breast cancer cases were recorded in the UMCG. From the data collected from HEBON we conclude that 18 (3.47%) patients with primary DCIS tumours would have been miss-diagnosed if only screened with MRI and not with mammography. As we did not review the images yet this is a preliminary conclusion with the data collected so far. In addition, from the BRCA1/2 mutation analysis we conclude that the tumours formed by these gene mutations are both diagnosed at a mean age of approximately 35 years old. Tumours formed by BRCA1 mutations are mostly invasive ductal carcinomas, larger than 2cm and poorly differentiated (grade 3-4). DCIS tumours are 84.33% more often found in BRCA2 mutation carriers than in BRCA1 mutation carriers. BRCA2 mutation carriers usually have moderately differentiated tumours of grade 2,3,4 and are smaller than 2cm. Whether the tumours develop in either the right or the left breast is almost equal for the lateralisation as well as the mutation gene.

Item Type:	Thesis (Thesis)
Supervisor name:	Bock, Prof. Dr. G.H. De
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:04
Last Modified:	25 Jun 2020 11:04
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2361

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