Thirteen-year experience of high risk breast cancer surveillance for female BRCA mutation carriers in Hong Kong

Abstract

Aim: Long‐term results of high‐risk breast cancer surveillance for BRCA mutation carriers are lacking for Asian population. This study aimed to review our 13‐year experience of high‐risk surveillance and assess the outcome of cancer detection and mortality. Methods: BRCA mutation carriers under Hong Kong Hereditary Breast Cancer Family Registry from January 2007 to December 2019 were reviewed. Surveillance program included biannual clinical examination, 6‐monthly breast imaging with alternating contrast magnetic resonance imaging and a combination of mammogram and ultrasound. Results: A total of 419 BRCA mutation carriers were managed under the registry; after excluding patients who had bilateral mastectomy before enrolling to the program, 346 patients were followed up in a median period of 39.4 (6–152) months. The uptake of risk‐reducing mastectomy was 5%, and particularly low in patients without breast cancer, only 2%. The new breast cancer detection rate was 1.75% (29 cancer diagnosed from 1656 screening imaging). Early cancer detection was achieved with 86.7% diagnosed in stage 0/1 and a node positive rate of 6.7%, with minimal interval cancer occurrence. Overall breast‐cancer specific mortality was 3.8%. In initially breast‐cancer free patients who later developed breast cancer during surveillance, breast‐cancer specific mortality was 0%. Overall survival was largely dependent on ovarian cancer history. Conclusions: Risk‐reducing mastectomy is not popular among Chinese BRCA mutation carriers. High‐risk breast cancer surveillance remained the core management and it could achieve early cancer detection with minimal interval cancer occurrence, and a low breast‐cancer specific mortality. Further study with cost‐effective analysis is warranted.