Effective Surveillance of High-Risk Women

Two hundred women identified as high risk were followed with intensified screening for 5 years for a prior history of atypical hyperplasia, lobular carcinoma in situ, or a family history of breast cancer. Over the 5-year period, 60 women dropped out of the screening regimen and 7 patients were diagnosed with 8 breast cancers. Six of the breast cancers were diagnosed on screening M Rls, and 2 were diagnosed on screening mammograms. The calculated risk assessment scores did not correlate with increased development of breast cancers in our population, indicating that re-evaluation of risk assessment and screening protocols is warranted. Background: This study addresses the effectiveness of risk models and screening breast magnetic resonance imaging (MRI) in women who have atypical hyperplasia (AH), lobular carcinoma in situ (LCIS), or a family history of breast cancer, but not a genetic mutation. Patients and Methods: A retrospective review of 444 women who had 458 breast screening MRIs at a community teaching hospital over a 12-month period between March 25, 2014 and March 31, 2015 was performed. The patients underwent high risk screening with breast MRIs alternating with mammograms every 6 months. After excluding patients with prior breast or ovarian cancer, genetic mutations, and chest wall radiation, 200 remaining patients constituted the study cohort. Over the following 5 years, the patients were screened with MRIs alternating with mammograms every 6 months. A total of 961 total MRI screenings were performed over the entire 5-year period of the study. Results: A total of 200 women fit the study criteria. Of these 103 had a prior history of AH or LCIS. Over the 5-year period, 60 women dropped out of the screening regimen, 6 patients were diagnosed with breast cancer on screening MRIs, and 2 additional patients were diagnosed with breast cancer on screening mammograms. Surprisingly, the highest Tyrer-Cuzick (T-C) scores did not correlate with increased development of breast cancers in our population. Conclusions: This study shows that there is wide variation in the results of risk assessment models. Risk models may overestimate breast cancer risk, suggesting that re-evaluation of current risk assessment and screening protocols is warranted. (C) 2021 Elsevier Inc. All rights reserved.