DALILA AHNOU Radiology Breast Unit, University Hospital Beni Messous, Alger, Algeria
5-10% of breast cancers are linked to a major genetic predisposition. Constitutional mutations of the BRCA1 and BRCA2 genes account for 65% of predispositions. The cumulative risk of breast cancer at the age of 70 is 65% and 45% in case of BRCA1 and BRCA2 mutations, at the age of 50 it is 38% and 16%.
For women with a mutation or high probability of genetic predisposition, breast cancer screening by clinical examination and mammography alone are not very effective. Since 2004, several prospective single-center and multicenter trials have evaluated MRI compared with mammography and ultrasound in the surveillance of the at-risk population. All have demonstrated the significant superiority of MRI in detecting breast cancer compared with the other techniques.
The experts recommend starting MRI screening at age 30, they suggest that screening should continue until age 65. The combination of a mammogram with a single external oblique incidence per breast, in full field digital technique. Several studies have reported that familial breast cancer most often has benign morphologic features, unlike sporadic breast cancer.
The accepted imaging strategy is to perform an annual MRI examination, followed by a mammogram within a month. This scheduling order allows, in case of a positive MRI, to perform a targeted assessment by standard imaging. This multimodal evaluation should be summarized in a report with a single ACR classification per breast.
Keywords: breast cancer; BRCA1/2 mutation; magnetic resonance imaging; mammography; screening
