Screening by mammography, women with a family history of breast cancer

Lalloo, Fiona; Boggis, Caroline; Evans, D. Gareth; Shenton, Andrew; Threlfall, Anthony; Howell, Anthony

doi:10.1016/s0959-8049(98)00005-7

Cited by 65 publications

(39 citation statements)

References 12 publications

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“…Studies, including one from Scotland (Julian-Reynier et al, 1996;Lalloo et al, 1998;McLeish, 2003), have shown that women with a family history of breast cancer place access to regular mammography as their highest priority and indeed, so long as that is provided, they are content to forego specialist genetic assessment and counselling . The counterpart of that is that some women, when told their risk falls below guidelines' threshold, will resent exclusion from a surveillance programme.…”

Section: Resultsmentioning

confidence: 99%

Familial breast cancer: management of ‘lower risk’ referrals

et al. 2006

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Up to 40% of referrals from primary care to 'breast cancer family clinics' prove to be of women whose assessed risk falls below the guidelines' threshold for management in secondary or tertiary care, despite recommendations that they should be screened out at primary care level. A randomised trial, involving 87 such women referred to the Tayside Familial Breast Cancer Service compared two ways of communicating risk information, letter or personal interview. Both were found to be acceptable to referred women and to their family doctors, although the former expressed a slight preference for interview. Only four women returned to their family doctors with continuing concerns about breast cancer. Nevertheless, understanding of information provided by either route was unsatisfactory, with apparent confusion about both absolute and relative risks of breast cancer. Substantial minorities appear to believe that they are at no increased risk at all, or even below the population level of risk, while others remain convinced that their personal risk has been underestimated. Family history record forms, completed by the referred women, preferably with the assistance of relatives, are crucial to full assessment of familial risk but one quarter of women referred to the Tayside Familial Breast Cancer Service currently do not complete and return these forms ahead of their clinic appointment. Further collaboration between primary care and the Breast Cancer Family Service is required to improve provision for concerned women whose risks fall below the threshold for special surveillance and to maximise effective use of the family history record form.

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Section: Resultsmentioning

confidence: 99%

Familial breast cancer: management of ‘lower risk’ referrals

et al. 2006

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“…For comparison, we should consider that several screening studies of high-risk women by using mammography without contrast-enhanced MR imaging have shown an incidence of positive nodes of 30%-45% (44,48,49).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Comparative Multimodality Surveillance of Women at Genetic-Familial High Risk for Breast Cancer (HIBCRIT Study): Interim Results

Sardanelli¹,

Podo²,

D'Agnolo³

et al. 2007

Radiology

322

176

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For the High Breast Cancer Risk Italian Trial (HIBCRIT) Purpose:To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material-enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic findings as standard. Materials and Methods:Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in firstor second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age). Results:Two Conclusion:Addition of MR imaging to the screening regimen for highrisk women may enable detection of otherwise unsuspected breast cancers.

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“…The tendency for a significant proportion of gene carriers (particularly BRCA1) to have oestrogen-receptor-negative breast cancer suggests limited efficacy of SERMS in the treatment of breast cancer in this group (Lakhani et al, 2002). There is limited evidence on the efficacy of mammography in pre-menopausal women, although some benefit is likely for those over age 40 (Lalloo et al, 1998;Moller et al, 2002). Lack of efficacy may be due to screening trials assessing younger age groups (i.e.…”

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confidence: 99%

Psychosocial impact of breast/ovarian (BRCA 1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort

et al. 2004

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This multi-centre UK study assesses the impact of predictive testing for breast and ovarian cancer predisposition genes (BRCA1/2) in the clinical context. In the year following predictive testing, 261 adults (59 male) from nine UK genetics centres participated; 91 gene mutation carriers and 170 noncarriers. Self-report questionnaires were completed at baseline (pre-genetic testing) and 1, 4 and 12 months following the genetic test result. Men were assessed for general mental health (by general health questionnaire (GHQ)) and women for general mental health, cancer-related worry, intrusive and avoidant thoughts, perception of risk and risk management behaviour. Main comparisons were between female carriers and noncarriers on all measures and men and women for general mental health. Female noncarriers benefited psychologically, with significant reductions in cancer-related worry following testing (Po0.001). However, younger female carriers (o50 years) showed a rise in cancer-related worry 1 month post-testing (Po0.05). This returned to pre-testing baseline levels 12 months later, but worry remained significantly higher than noncarriers throughout (Po0.01). There were no significant differences in GHQ scores between males and females (both carriers and noncarriers) at any time point. Female carriers engaged in significantly more risk management strategies than noncarriers in the year following testing (e.g. mammograms; 92% carriers vs 30% noncarriers). In the 12 months post-testing, 28% carriers had bilateral risk-reducing mastectomy and 31% oophorectomy. Oophorectomy was confined to older (mean 41 yrs) women who already had children. However, worry about cancer was not assuaged by surgery following genetic testing, and this requires further investigation. In all, 20% of female carriers reported insurance problems. The data show persistent worry in younger female gene carriers and confirm changes in risk management consistent with carrier status. Men were not adversely affected by genetic testing in terms of their general mental health.

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Screening by mammography, women with a family history of breast cancer

Cited by 65 publications

References 12 publications

Familial breast cancer: management of ‘lower risk’ referrals

Familial breast cancer: management of ‘lower risk’ referrals

Multicenter Comparative Multimodality Surveillance of Women at Genetic-Familial High Risk for Breast Cancer (HIBCRIT Study): Interim Results

Psychosocial impact of breast/ovarian (BRCA 1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort

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