BRCA1or2突变的女性中乳腺癌发病率及分期的前瞻性研究.pdf

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1、AProspectiveStudyofBreastCancerIncidenceandStageDistributioninWomenwithaBRCA1orBRCA2MutationunderSurveillancewithandwithoutMagneticResonanceImaging•Dr.Causerhasnorelevantfinancialrelationshipstodisclose.•Dr.Hillhasnorelevantfinancialrelationshipstodisclose.•Dr.Jonghasnorelevantfinancialrelationship

2、stodisclose.•Dr.Narodhasnorelevantfinancialrelationshipstodisclose.•Dr.Pleweshasnorelevantfinancialrelationshipstodisclose.•Dr.Sunhasnorelevantfinancialrelationshipstodisclose.•Dr.WarnerhasdoneconsultingworkforBerlexandBayer.•Dr.Wonghasnorelevantfinancialrelationshipstodisclose.•Dr.Wrighthasnorelev

3、antfinancialrelationshipstodisclose.•Dr.Yaffehasnorelevantfinancialrelationshipstodisclose.2009AProspectiveStudyofBreastCancerIncidenceandStageDistributioninWomenwithaBRCA1orBRCA2MutationunderSurveillanceWithandWithoutMRIWarnerE,HillKA,CauserP,PlewesDB,JongR,YaffeM,WongJ,WrightFC,Sun,P,NarodSAIBrea

4、stCancerRiskinWomenBRCAMutations•45%-65%risktoage70(Antoniou2003)•Options:orRiskReducingMastectomyBreastSurveillance(±reconstruction)BreastSurveillanceforVeryHighRiskWomenSensitivitySpecificityMammography32%99%MRI75%96%Mammography+84%95%MRIWarneretal.SystematicReview,AnnIntMed2008Questions1)Doesadd

5、ingMRItomammographysurveillancereducemortality?2)“HowlikelyamItodieofbreastcancerifIoptforsurveillance”?PotentialStudies•RandomizedControlledTrial•Prospectivecohortstudy–Ideal–NotquiteidealProspectiveCohortStudy•WomenwithBRCAmutationsonbreastsurveillance–‘MRIcohort’–„Controlcohort’Objectives•Primar

6、y–Distantrecurrencerates–Overallsurvival•Secondary–Cancerincidence–Cancerstage“Everybreastcancerscreeningstudythathasshownasignificant,favorablestageshifthasultimatelyshownamortalityreduction.”RobertSmith,PhD(cancerepidemiologist)2009HypothesesMRIcohortwillhave:1)DCIS2)stageIcancers3)↓stagesIItoI

7、VcancersPatients&MethodsMRICohortControlCohortn445830MutationStatusBRCA1orBRCA2BRCA1orBRCA2Age25-6525-65CentersToronto–Sunnybrook13acrossNorthAmericaEnrollment1997-20071995-2005PreviousyesyescancerScreening