Correspondence: Maria Javed
NHSBSP high risk screening programme (HRSP) for family history and supradiaphragmatic irradiation (SRT) commenced in April 2013. The outcomes, cancer detection rates (CDR), and modality of detection in our institution were reviewed.
We retrospectively reviewed HRSP breast cancers between April 2013-2018. High risk category, diagnosis, lesion characteristics, imaging modality of cancer detection, biopsy method, and surgical histology were recorded.
There were 28 cancers (27/1160 screened) consisting of 19 invasive and 9 non-invasive cancers. Only 2 patients required MRI biopsy.
CDR was highest in BRCA1 women (42/1000; 13/313). All were invasive cancers. Cancers presented mainly as masses (92%; 12/13), with microcalcifications in only 1 patient. MRI had 100 % (9/9) detection rate. 6 had MRI and mammograms, with 4 mammogram occult cancers (67%).
There were 7 BRCA2 cancers consisting of 3 invasive and 4 DCIS (CDR 23/1000;7/307). Four were microcalcifications and 3 masses. There was 1 MRI detected mammographic occult cancer with a further 2 MRI detected malignant masses.
SRT had a CDR of 37.5/1000 (6/160) presenting as 4 masses and 2 microcalcification (4 invasive and 2 DCIS). Mammogram detected 4 and MRI detected 2 cancers.
There was only 1 Equivalent risk cancer (DCIS; CDR 16/1000, 1/63).
In summary, our study demonstrated that BRCA 1 carriers have the highest CDR, presenting mostly as masses, best detected on MRI, and frequently mammogram occult. BRCA 2 and SRT have a high rate of associated cancers, detected as microcalcification or masses, with a large proportion detected on mammograms. MRI biopsy was infrequently required.