Worldwide incidence of carcinoma of the breast is higher than other malignancies among women. In the Netherlands, the breast cancer incidence has increased to a high level and approximately one out of seven women will develop breast cancer during their lifetime. Although the incidence has increased, the mortality has decreased during the last two decades and at the moment the risk of dying is 1 in 32. Five to ten percent of all breast cancer cases are hereditary, with germline mutations in the BRCA1, BRCA2 and CHEK-2 (1100delC) genes accounting for less than 40% of these cases. Thus, the majority of hereditary breast cancer is due to other germline mutations in as yet unknown genes. In the Netherlands, approximately 20% of familial breast cancer is caused by BRCA1, 5% is caused by BRCA2 and 75% is non-BRCA1/BRCA2. Furthermore, there are other genes predisposing to a markedly increased risk of breast cancer (e.g.TP53, PTEN, STK11, CDH1). Besides proven germline mutation carriers, also women with a personal life time breast cancer risk ≥ 25% and radiation therapy of the chest before the age of 40 participate in a screening programme. Mammography and dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) are used as standard modalities for breast cancer screening in these (genetically) high risk women.
The purpose of the study, therefore, is to determine the added value of multivoxel MRS in equivocal breast lesions detected through screening with DCE-MRI. This study will especially focus on young women with a high risk of breast cancer.
The hypothesis is that with the application of a DCE-MRI scan with quantitative multivoxel MRS, 23% of the number of false positive breast lesions and related to that, the number of unnecessary invasive procedures, will be prevented as compared to a regular DCE-MRI. This means that unnecessary biopsy can be prevented in case of a benign lesion. When a woman has proven breast cancer and more enhancing breast lesions are present in the same breast (or contralateral breast) which are benign, unnecessary extended breast surgery can be prevented with multivoxel MRS and thereby overtreatment.
The expectation is that women prefer the new non-invasive diagnostic work-up instead of the biopsy, and that this, when implemented in clinical practice will improve the quality of life of the women involved.
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