P10: High Risk Screening in Women with BRCA1/2 Mutations Age 70 and Above

Friday, March 24, 2023

12:36 PM – 12:41 PM

Location: SSO HUB: Breast & Endocrine Zone

Poster Presenter(s)

Astrid M. Botty van den Bruele, MD

Assistant Professor of Surgery
Duke University Hospital
Durham, North Carolina, United States

Disclosure information not submitted.

Author(s)

YR

Yi Ren, MS

Biostatistician III
Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States

Disclosure information not submitted.
ST

Samantha M. Thomas, MS

Biostatistician
Biostatistics and Bioinformatics, Duke University, United States

Disclosure information not submitted.
MR

Marguerite Rooney, MS

Medical Student
Duke University Hospital, United States

Disclosure information not submitted.
CM

Carolyn S. Menendez, MD

Assistant Professor
Department of Surgery, Duke University, United States

Disclosure information not submitted.
AC

Akiko Chiba, MD

Assistant Professor of Surgery
Duke University Hospital, United States

Disclosure information not submitted.
LG

Lars Grimm, MD

Assistant Professor
Duke University Hospital, United States

Disclosure information not submitted.
Jennifer K. Plichta, MD, MS

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Jennifer K. Plichta, MD, MS: No financial relationships to disclose

Introduction: The risk of developing breast cancer up to age 80 for women with BRCA1/2 mutations is approximately 69-72%. These risk estimates, however, become labile in the later years of life. Screening recommendations may be individualized for those who do not undergo risk-reducing mastectomies (RRM). Many older (age ≥70) women with BRCA1/2 mutations continue to undergo routine high-risk screening (HRS). Given the paucity of data guiding when to de-escalate HRS in older women with BRCA1/2 mutations, we sought to estimate how many breast cancers were diagnosed at age ≥70 and, if applicable, which imaging modality identified the malignancy.

Methods: Retrospective chart review identified adult female patients with BRCA1/2 pathogenic/likely pathogenic mutations. Those who had undergone RRM, had a prior breast cancer diagnosis at the time of genetic testing, had missing dates/data, and/or were age ≤30 years at the time of genetic testing were excluded. The cohort was divided into 3 age groups (30-59, 60-69 and ≥70). The imaging modality was recorded, as well as the number of malignancies discovered. Chi-squared tests were used to compare categorical variables, and ANOVA tests were used to compare continuous variables.

Results: The final cohort consisted of 316 patients with BRCA1/2 mutations: 266 (84.2%) were age 30-59 at the time of genetic testing, 35 (11.1%) were 60-69, and 15 (4.7%) were ≥70. The overall median follow up was 4.75 years (IQR 1.8-9.55), which varied by group [age 30-59: 5.35 years (IQR 1.9-10.3), age 60-69: 2.7 years (IQR 1-6.4), age ≥70: 1.5 years (IQR 0.9-4.1); p=0.002]. There were 178 (56.3%) breast malignancies diagnosed, which also varied by group [age 30-59: 161 (60.5%), age 60-69: 11 (31.4%), age ≥70: 6 (40%); p=0.002]. Forty-three (24.2%) of these patients had their cancers discovered on MMG and 25 (14%) on MRI. In those age ≥70, 3 (50%) were identified on MMG, and none were identified on MRI.

Conclusions: Though these numbers are limited, our findings suggest that HRS in older patients with BRCA1/2 mutations may not be diagnosing significantly more cancers, and annual mammograms alone may be sufficient for many women. Given that a number of these high-risk patients will never develop breast cancer, our data support individualized and potentially de-escalated screening in the later years of life.

Learning Objectives:

Upon completion, participant will be able to identify the paucity of data regarding high risk screening in BRCA+ patients over the age of 70
Upon completion, participant will be able to surmise the limited role of MRI in BRCA+ patients over the age of 70
Upon completion, participant will be able to help make individualized screening recommendations in BRCA+ patients over the age of 70