MRI for High Risk Breast Cancer Screening and Surveillance
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Routine mammography is an effective method for women with an average risk for breast cancer, especially for older women. However, women at higher risk, either by virtue of family history or as known carriers of genetic risk factors (i.e., BRCA1 or 2), are not well served by mammography. We need to begin screening these women at a much younger age- whenre mammography is ineffective due to higher breast density. And, we need to detect breast tumors at the earliest possible stage to initiate effective treatment. Our interest is in the use of a more sensitive breast cancer detection method, called Magnetic Resonance Imaging (MRI). This method, although more costly than mammography, can detect very small tumors and is useful when applied to younger women. Today, some women at high-risk choose prophylactic mastectomy, a procedure that reduces the incidence of breast cancer by up to 90%. We hope that MRI will give these women the confidence to avoid this drastic procedure, and improve their quality of life.
 
 
 
 
 
 
 
 While breast MRI may provide an effective, alternative screening and surveillance method for women at high-risk, more research is needed to validate its accuracy and clinical utility in special groups of women. Our research collaboration combines a strong, existing basic research program in breast MRI (Nola Hylton) with the genetic and epidemiological resources of the UCSF Cancer Risk Program (John Ziegler). The UCSF MRI service is a national leader in breast cancer imaging. The Cancer Risk Program counsels and tests women at high-risk of hereditary cancer. We plan to recruit 30 women per year to the study. These subjects include both, (i) those with lifetime risk levels exceeding 30% by monogenetic non-genetic testing methods, (ii) women who carry mutations in BRCA1 or BRCA2 susceptibility genes, or (iii) women whose probability (based on family history) of carrying BRCA mutations is 10% or greater. Each woman will undergo one initial screening MRI exam and onea yearly, follow-up MRI exam at 1 year. These same groups of women will also be screened using standard mammography and physical examination, so we can measure any increased detection by the more sensitive MRI method.
 
 
 
 
 
 
 
 Being in a high-risk population for breast cancer has profound physiological psychological impact. Even in the absence of disease there is potential reduced quality of life. To address this issue, we will conduct a survey to determine whether using MRI screening reduces anxiety for some women. In many cases, we will recommend MR-guided biopsy to investigate suspicious lesions found on the MR image. In all cases, including those without suspicious findings, we will ask patients to voluntarily contribute tissue samples obtained by MR-guided needle biopsy during their MRI. The samples will allow us to correlate biological properties of tissue with different imaging patterns on MRI.
 
 
 
 
 
 
 
 Ultimately we hope to gain knowledge both in employing the MRI technique and in our counseling patterns/psychological impact on the different groups of high-risk women. By applying MRI to high-risk patients we can refine the criteria for diagnosis and screening. This information will increase the diagnostic performance of breast MRI, and hopefully identify breast cancer earlier than with other techniques.