Study: Early screening could halve number of breast cancer deaths among young women

By Mark Waghorn via SWNS

Early screening could halve the number of breast cancer deaths among vulnerable young women, according to new research.

Annual magnetic resonance imaging (MRI) scans starting from 30 to 35 may slash mortality by more than 50 percent, say scientists.

They would be offered to those with gene mutations that increase risk of the disease - years before routine mammograms.

The mutations are known as ATM, CHEK2 and PALB2 - and are as dangerous as a faulty BRCA gene famously carried by Angelina Jolie.

Lead author Dr. Kathryn Lowry, of the University of Washington, said: "Screening guidelines have been difficult to develop for these women because there haven't been clinical trials to inform when to start and how to screen."

The findings are based on computer simulations using data on more than 32,000 patients and a similar number of breast cancer-free women.

Dr. Lowry said: "For women with pathogenic variants in these genes, our modeling analysis predicted a lifetime risk of developing breast cancer at 21% to 40%, depending on the variant.

"We project starting annual MRI screening at age 30 to 35, with annual mammography starting at age 40, will reduce cancer mortality for these populations of women by more than 50 percent."

Later diagnosis has been found to double younger women's risk of breast cancer spreading.

Girls Aloud singer Sarah Harding died of the disease last year. She was just 39.

The study in JAMA Oncology compared the combined performance of mammography and MRI against mammography alone.

It projected 12-monthly MRI check-ups conferred a significant additional benefit to these populations.

Dr. Lowry said: "We also found starting mammograms earlier than age 40 did not have a meaningful benefit but increased false-positive screens."

These are cases in which women are wrongly told they might have breast cancer - leading to anxiety and unnecessary biopsies.

Senior author Professor Jeanne Mandelblatt, of Georgetown Lombardi Comprehensive Cancer Center, said: "Modelling is a powerful tool to synthesize and extend clinical trial and national cohort data to estimate the benefits and harms of different cancer control strategies at population levels."

The simulations predicted about four false-positive results and one to two benign biopsies per woman over a 40-year screening span.

To realize a benefit of cancer screening guidelines based on genetic susceptibility, a woman would need to know she carries an implicated variant before receiving a disease diagnosis.

More often a genetic test panel is administered after someone tests positive - too late to be of preventive value for the patient but potentially life-saving for blood relatives who could seek genetic testing.

Senior author Dr Mark Robson, chief of the Breast Medicine Service at the Memorial Sloan Kettering Cancer Centre, said: "People understand very well the value of testing for variants in BRCA1 and BRCA2, the most common breast cancer predisposition genes.

"These results show testing other genes, like ATM, CHEK2, and PALB2, can also lead to improved outcomes."

Angelina Jolie had her breasts removed in 2013 because she carried a BRCA1 mutation that put her at increased risk of breast cancer.

She later had her ovaries and fallopian tubes taken out to prevent her developing ovarian cancer. The illness killed her mother at the age of 56.

The researchers hope the analysis will aid the National Comprehensive Cancer Network, the American Cancer Society and other organisations that issue guidance for medical oncologists and radiologists.

Senior author Prof Allison Kurian, of Stanford University, California, added: "Overall what we are proposing is slightly earlier screening than what the current guidelines suggest for some women with these variants.

"For example, current NCCN guidelines recommend starting at age 30 for women with PALB2, and at 40 for ATM and CHEK2.

"Our results suggest that starting MRI at age 30 to 35 appears beneficial for women with any of the three variants."

In under 35s, the likelihood of a breast tumour migrating, or 'metastasising', to other parts of the body can rise by more than a third.

In November, a global study found they are much more vulnerable than over 50s who are offered regular screening.

Around 2.3 million people worldwide are diagnosed with breast cancer each year.

The NHS screening program offers three yearly mammograms to over 50s. There have been calls to lower the age limit.

Recent research found offering them to over 40s would prevent 300 deaths annually – mostly among younger women.

Breast cancer kills 685,000 women every year.