Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1
Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and pr...
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Published in | Familial cancer Vol. 22; no. 4; pp. 499 - 511 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Dordrecht
Springer Netherlands
01.10.2023
Springer Nature B.V |
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Abstract | Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.
Twenty-seven women (30–47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a
BRCA
pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.
The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than
BRCA
PV carriers (47.3%), which is an independent risk factor for breast cancer.
Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable. |
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AbstractList | Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.
Twenty-seven women (30–47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a
BRCA
pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.
The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than
BRCA
PV carriers (47.3%), which is an independent risk factor for breast cancer.
Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable. Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30–47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable. |
Author | Thiyagarajan, Lavvina Thompson, Jeff Fleming, Jane Moore, Katrina Field, Michael Schlub, Timothy E. Crook, Ashley Berman, Yemima Choi, Sarah Reddy, Ranjani Wilding, Mathilda |
Author_xml | – sequence: 1 givenname: Mathilda orcidid: 0000-0001-6054-039X surname: Wilding fullname: Wilding, Mathilda email: mathilda.wilding@health.nsw.gov.au organization: NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital – sequence: 2 givenname: Jane orcidid: 0000-0003-1164-2386 surname: Fleming fullname: Fleming, Jane organization: Department of Clinical Genetics, Royal North Shore Hospital – sequence: 3 givenname: Katrina orcidid: 0000-0003-4382-6702 surname: Moore fullname: Moore, Katrina organization: Department of Endocrine Surgery, Royal North Shore Hospital – sequence: 4 givenname: Ashley orcidid: 0000-0001-5578-0460 surname: Crook fullname: Crook, Ashley organization: NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital – sequence: 5 givenname: Ranjani surname: Reddy fullname: Reddy, Ranjani organization: North Shore Radiology & Nuclear Medicine – sequence: 6 givenname: Sarah surname: Choi fullname: Choi, Sarah organization: North Shore Radiology & Nuclear Medicine – sequence: 7 givenname: Timothy E. orcidid: 0000-0001-7746-9649 surname: Schlub fullname: Schlub, Timothy E. organization: Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney – sequence: 8 givenname: Michael orcidid: 0000-0001-7455-934X surname: Field fullname: Field, Michael organization: NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital – sequence: 9 givenname: Lavvina orcidid: 0000-0002-8415-9371 surname: Thiyagarajan fullname: Thiyagarajan, Lavvina organization: Department of Clinical Genetics, Royal North Shore Hospital – sequence: 10 givenname: Jeff surname: Thompson fullname: Thompson, Jeff organization: Northern Clinical School, Faculty of Health and Medicine, University of Sydney – sequence: 11 givenname: Yemima orcidid: 0000-0003-2495-4928 surname: Berman fullname: Berman, Yemima organization: Department of Clinical Genetics, Royal North Shore Hospital |
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Keywords | BI-RADS lesions Mammogram Breast density MRI Neurofibromatosis Breast cancer screening |
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SubjectTerms | Biomedical and Life Sciences Biomedicine Biopsy Breast cancer Cancer Research Epidemiology Genetic disorders Human Genetics Magnetic resonance imaging Mammography Neurofibromatosis Neurological disorders Original Article Recklinghausen's disease Risk factors Tumors |
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Title | Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1 |
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