BRCA Surveillance — SCE Medical Oncology MCQ

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ModerateCancer GeneticsBRCA SurveillanceSCE Medical Oncology

A 30-year-old woman with a known BRCA1 mutation has annual breast MRI. The current MRI shows a 7 mm enhancing lesion in the left breast not seen on mammography or ultrasound. What is the next step?

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Correct answer: B — MRI-guided biopsy (vacuum-assisted)

In BRCA1/2 carriers undergoing enhanced surveillance with annual breast MRI, new enhancing lesions require tissue diagnosis. MRI-guided vacuum-assisted biopsy is the appropriate approach for MRI-only visible lesions. Annual MRI has higher sensitivity than mammography for BRCA-associated breast cancers (particularly in dense breast tissue and younger women). The sensitivity of MRI in BRCA carriers is approximately 77-91% compared with 33-59% for mammography (MARIBS trial).

Reference: NICE CG164 Familial breast cancer; MARIBS trial Leach et al Lancet 2005; ESMO 2024 Hereditary Cancer Guidelines