Bi-annual MRIs helps high risk breast cancer patients

An MRI every six months could be far more effective in detecting breast cancer in younger women with a high-risk genetic profile than an annual mammogram, according to researchers.

The findings showed that undergoing a dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) every six months helped “downstage” aggressive breast cancer by finding small early lesions in women with high-risk mutations -- that are crucial to improving outcomes.

The DCE-MRI scans detected node-negative, invasive tumours less than one centimetre and performed especially well in young women with BRCA1 mutation - which increases the risk for aggressive subtypes of breast cancer.

“Mammograms remain important for most women. But for women at high risk who are getting a DCE-MRI every six months, annual mammograms could probably be eliminated,” said a Prof.

“For this group of younger women at significantly elevated risk, especially those with a BRCA1 mutation, we strongly support getting a DCE-MRI every six months,” the Dr. added. Between 2004 and December 2016, the researchers enrolled 305 women into a clinical trial with a lifetime breast cancer risk greater than 20 %, who were scheduled to undergo a clinical breast examination and a DCE-MRI scan every six months, and a digital mammogram every 12 months. 

The DCE-MRI curtailed the spread of the cancers to the lymph nodes as well as detected tumours smaller than a centimetre. “This study demonstrates, for the first time, that aggressive breast cancers can be caught early, without excessive recalls or biopsies,” the Dr. said. 

The researchers also suggested that all women should test for BRCA1 and BRCA2 at about age 30, regardless of personal or family history of cancer. that would detect mutations and help early action at preventing cancer.

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Genetic test could help fight secondary breast cancer

Thousands of breast cancer patients at risk of developing aggressive secondary tumours could benefit from a potential new genetic test.

A study led by researchers has shown women with breast cancer who lack a key genetic marker are more likely to respond to a treatment that can prevent the disease spreading to their bones.

Secondary cancer, known as metastasis, is the most common cause of death in breast cancer patients as there are few effective treatments once it has taken root.

It occurs when cancer cells spread to another site in the body. Around 70 per cent of secondary breast cancer patients have tumours in the bone.

Large scale clinical trials indicate a group of bone strengthening drugs known as bisphosphonates can help prevent the disease from spreading to bone in breast cancer patients if given early enough.

"The difficulty is identifying which patients will benefit from these drugs," said a professor of medical oncology who led the new study.

"It only seems to be effective in some patients, particularly older women, while others show no response and in some younger women it may even be harmful," Prof. said.

The new study has shown it may be possible to identify women who will benefit from bisphosphonates by using a test that looks for a gene known as MAF.

Women who do not carry the gene -- approximately 80 per cent of women with breast cancer -- were found to benefit from the bone strengthening treatment.

"If the test is negative for this gene, then they can be offered this bone strengthening treatment, which can give them a better chance of surviving their cancer," Coleman said.

"The discovery made and tested in the current study could be of great use to clinicians and would avoid unnecessary treatment of patients who would not benefit or could be harmed by the treatment," said Professor.

A test for the gene, known as MAFTest, has been developed by a  medical company called Inbiomotion.

The study was part of an international phase 3 clinical trial involving 3,360 women with stage II or III breast cancer.

The results need to be confirmed in a second trial, currently underway, before the test is likely to receive approval for wider use in patients.

If successful, it could be incorporated into the routine testing of breast cancer patients to see if they could benefit from bisphosphonate treatments such as zoledronic acid.

Those found not to carry the gene could be given the drug after having surgery and radiotherapy for their primary tumour in an effort to prevent the cancer from spreading.

Around more than 50,000 women are diagnosed with breast cancer each year and the disease claims the lives of at least 11,500 annually.

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