According to a study published in Radiology, a journal of the Radiological Society of North America (RSNA), breast tissue characteristics apparent on magnetic resonance imaging are linked to future risk of second breast cancer in women with a personal history of breast cancer. .
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide. While advances in treatment and early detection mean more women are surviving breast cancer, these women face a greater risk of developing a second breast cancer.
Breast cancer survivors with dense breasts face an even greater risk of a second cancer. Breast tissue is mostly fat, with areas of fibrous connective tissue and glandular tissue collectively known as fibroglandular tissue. Women with dense breasts have a greater proportion of fibroglandular tissue and less fatty tissue. This can obscure lesions on mammography and is an independent risk factor for breast cancer.
Breast MRI has become the method of choice for women with a personal history of breast cancer. Previous studies have shown that breast MRI has a higher cancer detection rate than mammography.
Postoperative surveillance breast MRI is increasingly being performed according to the American College of Radiology’s annual recommendation for women with dense breasts or diagnosed with breast cancer before age 50.”
Su Hyun Lee, MD, Ph.D., lead study author, Department of Radiology, Seoul National University Hospital in Seoul, Korea
Dr. Lee and colleagues studied the link between second cancer risk and background parenchymal enhancement (BPE) on breast MRI surveillance. BPE refers to the illumination, or enhancement, of background tissue on MRI after the administration of a contrast agent. The degree of BPE can vary between and within women. It is thought to be related to changes in the blood supply and permeability of breast tissue, which is affected by hormonal status. Breast cancer treatment in the form of radiation therapy, chemotherapy, or endocrine therapy can also alter the BPE of the treated breast.
BPE on contrast-enhanced breast MRI is a known risk factor for breast cancer. Less is known about the links between BPE on breast surveillance MRI and the risk of second breast cancer.
Of the 2,668 women in the study, 109 developed a second breast cancer with an average follow-up of 5.8 years. Mild, moderate, or marked BPE on breast surveillance MRI was independently associated with a higher risk of future second breast cancer compared with minimal BPE.
“The results suggest that BPE on postoperative surveillance breast MRI may indicate response to breast cancer treatment and may be a predictor of modified risk of second breast cancer after treatment in women with a personal history of breast cancer “said Dr. Lee.
The study’s findings point to the role of BPE measurements in refining screening pathways for women with previous breast cancer, Dr. Lee said.
“The results of our study may help to stratify the risk of second breast cancer in women with a personal history of breast cancer and to establish personalized imaging surveillance strategies in terms of imaging modality and follow-up interval selection,” he said. “For example, women with minimal BPE on breast surveillance MRI may no longer need to undergo a contrast-enhanced breast MRI every year if there are no other risk factors.”
These other risk factors include younger age at diagnosis, the presence of genetic mutations linked to breast cancer, and hormone receptor expression in the initial breast cancer.
Areas for future study include the link between BPE changes on preoperative screening or breast MRI and on postoperative surveillance breast MRI and the development of second breast cancer.
In the future, Dr. Lee hopes that risk models will use mammography, ultrasound and MRI together. This approach, he said, will lead to more tailored surveillance strategies for women with a history of breast cancer.
Source:
Radiological Society of North America