Abstract
For women with BRCA1 or BRCA2 mutations who require breast surveillance, annual MRI and mammography begun by age 30 detect over 90 % of cancers, and find cancers at a much earlier stage than mammography alone. The reported distant-recurrence rate is low, but long-term survival data are not yet available. Alternating the two imaging modalities every six months may be preferable to concurrent imaging. The incremental benefit from adding ultrasound or clinical breast examination is negligible. After the first year of surveillance the false-positive rate drops to approximately 10 %, with recalls and/or biopsies causing, at most, a transient increase in anxiety. Breast surveillance for this population is expensive but cost-effective. Further research is necessary to determine the optimum surveillance strategy for young BRCA1-mutation carriers and for women over 60 with either mutation.
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