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van CCT (UK)

van CCT (UK)

Can we use breast density measurement to indicate whether mammography or MRI can best be used to screen women with familial risk for breast cancer?

- candidate number9195
- NTR NumberNTR2789
- ISRCTNISRCTN wordt niet meer aangevraagd.
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR3-mrt-2011
- Secondary IDs2009-4491 / 200320002 / 2010-292; KWF EMCR / ZonMw / MEC Erasmus MC
- Public TitleCan we use breast density measurement to indicate whether mammography or MRI can best be used to screen women with familial risk for breast cancer?
- Scientific TitleBreast density in women with familial risk as indicator for the use of mammography or MRI to screen for breast cancer: A RCT.
- hypothesisA proportion of women with high familial breast cancer risk can be screened most effectively with MRI. Breast density may be the best predictor whether to screen this particular group of women with mammography or MRI.
- Healt Condition(s) or Problem(s) studiedBreast cancer, Screening, MRI, Mammography, Breast Density
- Inclusion criteria1. Cumulative Life Time Risk ≥20%, defined by Claus Adjusted Tables;
2. Age at inclusion 30-55 years, or 5 years younger than youngest case of breast cancer in family;
3. Willing to provide informed consent.
- Exclusion criteria1. Personal history of invasive (breast) cancer, except for basal cell carcinoma;
2. Having a (50% risk of a) known BRCA1, BRCA2 or P53 mutation;
3. Breast MRI contra-indications like kidney dysfunction or metal implantation.
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 15-jan-2011
- planned closingdate15-jan-2015
- Target number of participants2000
- Interventions1. MRI with clinical examination yearly + mammography every other year (year 1 + 3) (n=1000;
2. Mammography with clinical examination yearly (n=1000).
- Primary outcomeThe number of tumours detected at screening examinations and in between screening examinations (interval tumours), and the stage distribution at diagnosis in the different trial arms. The results will also be analyzed by density score.
- Secondary outcomeSensitivity, proportion of false-positive results and specificity of MRI and mammography in both arms. Furthermore breast cancer mortality reduction will be estimated using breast cancer microsimulation models (MISCAN). Cost effectiveness analyses will be performed. Costs will be calculated per quality adjusted life-year gained.
- TimepointsN/A
- Trial web
- statusopen: patient inclusion
- CONTACT for SCIENTIFIC QUERIESDr. M.M.A. Tilanus-Linthorst
- Sponsor/Initiator Erasmus Medical Center, Daniel den Hoed Cancer Center
- Funding
(Source(s) of Monetary or Material Support)
ZON-MW, The Netherlands Organization for Health Research and Development, KWF Kankerbestrijding
- PublicationsN/A
- Brief summaryTwenty-five percent of all breast cancers are detected before age 50 years. A positive family history is a major risk factor for breast cancer at a young age. In over 75% of the families that display clear clustering of breast cancer no causative mutation in the BRCA1, the BRCA2 or other genes can be detected. Women from these families cannot be tested to distinguish those with high from those with average risk of developing breast cancer.
Tumour stage at detection is of key influence on survival. Therefore Dutch guidelines advise regular breast surveillance to all women with a family history. For women with an estimated cumulative lifetime risk (CLTR) ≥20% yearly mammography between 40 and 50 years is advised. Yearly mammography and specialist clinical examination is advised for women with CLTR ≥30% between 35 and 60 years. Although due to screening tumours might be found at a more favourable tumour stage, screening also causes false-positive test results.
In the last decade several screening trials have been completed and MRI had a significant higher sensitivity than mammography in all studies. However in most studies MRI gave significantly more false-positive results and mammography had better sensitivity for Ductal Carcinoma in Situ (DCIS). Nevertheless for BRCA1/2 mutation carriers, who have a CLTR of 40-70%, screening with yearly MRI has been shown cost-effective.
For the larger group of women with familial risk, but without a proven BRCA1/2 mutation it is not clear whether additional MRI is advantageous for some: no separate cost-effectiveness results have been published yet. Since previous screening studies have performed MRI and mammography simultaneously the difference in stage of the tumours when detected by mammography alone is not known. A randomized controlled trial is needed therefore. Apart from family history and age high density of the breast tissue is the best documented and most important risk factor for breast cancer. Breast density may also strongly influence screening-results:
1. It increases breast cancer incidence significantly, but;
2. Decreases the sensitivity of mammography, though not of MRI, while;
3. False-positive findings at mammography may increase.
High breast density is prevalent in 60% of women below age 50.

Breast density may be the best predictor whether a woman with high familial breast cancer risk can be screened most effectively with mammography or MRI. If proven, breast density measurement can be used to apply the most effective screening tool to screen women with increased risk for breast cancer.
- Main changes (audit trail)
- RECORD3-mrt-2011 - 12-mrt-2011

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