Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis.
Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis.
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DOI：
10.1002/cncr.26424
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发表时间：
2012-04-15
期刊：
影响因子：
6.2
通讯作者：
Gazelle GS
中科院分区：
文献类型：
--
作者：
Lowry KP;Lee JM;Kong CY;McMahon PM;Gilmore ME;Cott Chubiz JE;Pisano ED;Gatsonis C;Ryan PD;Ozanne EM;Gazelle GS
虽然乳腺癌筛查与乳腺X线摄影和MRI推荐BRCA突变携带者，目前没有最佳的筛选方案的共识。我们使用计算机模拟模型比较了从25岁、30岁、35岁和40岁开始的六种年度筛查策略[胶片乳腺X线摄影（FM）、数字乳腺X线摄影（DM）、FM和磁共振成像（MRI）或DM和MRI同时进行，以及FM/MRI或DM/MRI交替6个月]，以及两种每年MRI和延迟交替DM/FM的策略与单独的临床监测。使用两种超额相对风险模型，评估了无和有乳房X线摄影诱发乳腺癌风险的策略。从医学文献、公开可用的数据库和校准中获得输入参数。在没有辐射风险影响的情况下，从25岁开始交替进行DM/MRI提供了最高的预期寿命（BRCA 1：72.52岁，BRCA 2：77.63岁）。当包括辐射风险时，一小部分诊断的癌症可归因于辐射暴露（BRCA 1：<2%，BRCA 2：<4%）。对于辐射风险，25岁时交替DM/MRI或25岁时每年MRI/30岁时延迟交替DM是最有效的，这取决于所使用的辐射风险模型。从25岁开始的交替DM/MRI也有最高的假阳性筛查人数/人（BRCA 1：4.5，BRCA 2：8.1）。在BRCA突变携带者中，25岁时每年MRI/30岁时延迟交替DM可能是最有效的筛查策略。筛选的好处，相关的风险和个人接受假阳性结果，应考虑在选择最佳的筛选策略为个别妇女。
While breast cancer screening with mammography and MRI is recommended for BRCA mutation carriers, there is no current consensus on the optimal screening regimen. We used a computer simulation model to compare six annual screening strategies [film mammography (FM), digital mammography (DM), FM and magnetic resonance imaging (MRI) or DM and MRI contemporaneously, and alternating FM/MRI or DM/MRI at six-month intervals] beginning at ages 25, 30, 35, and 40, and two strategies of annual MRI with delayed alternating DM/FM to clinical surveillance alone. Strategies were evaluated without and with mammography-induced breast cancer risk, using two models of excess relative risk. Input parameters were obtained from the medical literature, publicly available databases, and calibration. Without radiation risk effects, alternating DM/MRI starting at age 25 provided the highest life expectancy (BRCA1: 72.52 years, BRCA2: 77.63 years). When radiation risk was included, a small proportion of diagnosed cancers were attributable to radiation exposure (BRCA1: <2%, BRCA2: <4%). With radiation risk, alternating DM/MRI at age 25 or annual MRI at age 25/delayed alternating DM at age 30 were most effective, depending on the radiation risk model used. Alternating DM/MRI starting at age 25 also had the highest number of false-positive screens/person (BRCA1: 4.5, BRCA2: 8.1). Annual MRI at 25/delayed alternating DM at age 30 is likely the most effective screening strategy in BRCA mutation carriers. Screening benefits, associated risks and personal acceptance of false-positive results, should be considered in choosing the optimal screening strategy for individual women.
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影响因子：
3.8
作者：
Grann, Victor R.;Patel, Priya R.;Jacobson, Judith S.;Warner, Ellen;Heitjan, Daniel F.;Ashby-Thompson, Maxine;Hershman, Dawn L.;Neugut, Alfred I.
通讯作者：
Neugut, Alfred I.
影响因子：
5
作者：
Hendrick, R. Edward;Pisano, Etta D.;Gatsonis, Constantine
通讯作者：
Gatsonis, Constantine
影响因子：
158.5
作者：
Kriege, M;Brekelmans, CTM;Klijn, JGM
通讯作者：
Klijn, JGM
影响因子：
158.5
作者：
Pisano, ED;Gatsonis, C;Rebner, M
通讯作者：
Rebner, M
影响因子：
19.7
作者：
Pisano, Etta D.;Hendrick, R. Edward;Gatsonis, Constantine A.
通讯作者：
Gatsonis, Constantine A.