At “Modena Cancer Centre for Hereditary Breast and Ovarium Cancer” subgroups in the population with an elevated risk of BC can be identified by performing genetic testing for BC predisposition mutations or by evaluating family history.
In particular the oncogenetic counseling was performed in accordance with an oncologist-based model of cancer genetic counseling for hereditary breast cancer.
Family histories were obtained through detail questionnaires and interviews.
Family pedigrees were traced as far backward and laterally as possible,
including a minimum of four generations and extended to paternal lines.
A woman is considered to be at high risk for BC because of family or personal history of BC,
or because she carries a mutation in one on two breast cancer susceptibility genes BRCA1 or BRCA2,
or because the genetic test results positive on a first-degree relative.
Previously affected or healthy women with a pathogenetic or unclassified mutation enter into a surveillance program with ultrasound,
MR plus mammogram starting at 25 years of age.
Between January 2008 and April 2012,
118 women with high breast cancer risk (mean age 46 years,
range 25-75 years) [Table 1] were enclosed in a screening annual program with MX,
US and MR.
All women of this study carried BRCA1 or BRCA2 mutation; all age groups are included.
All these techniques were performed on the same day by different doctors,
all expert in radiology.
Mammography was performed in two different projections for each breast (cranio-caudal and medio-lateral) with digital indirect technology.
Ultrasound was performed with high frequency probe and breast dedicated preset.
MRI was performed with a 1.5 T magnet and surface coil,
during the second or third week of the hormonal cycle.
MRI protocol included pre-contrast T2w and DW sequences,
coronal dynamic T1w acquisition before and after contrast injection for a total time of 10 minutes and also an axial T1w sequence with late enhancement.
The post-processing of dynamic sequence included an automatically images subtraction,
the assessment of the intensity-time curves for kinetic enhancement evaluation and the MIP reconstruction.
When present MR examinations were compared with the previous round examinations.
When MRI showed some focal areas of enhancement without correspondence with other examinations,
second look ultrasound was performed,
with a cyto-hysto-evaluation if indicated.
Lesions detected with different techniques were classified according BIRADS-MRI system.
In particular we evaluated the tumors screen detected with different imaging techniques.
We evaluated also the US second look number performed after MR in each round and the false positive results with cito-hystology confirmation for each imaging techniques in each round.