Adherence to mammogram (MMG) screening guidelines in BRCA1/2 mutation carriers.

583 Background: MMG is routinely recommended for breast cancer screening in women with BRCA1 or BRCA2 mutations, usually beginning at or before age 25. However, previous studies have described poor screening adherence, especially among young carriers. In these studies, only 39-45% of unaffected carriers under age 40 participated in screening one year after genetic testing. These studies also suggested a decline in screening adherence with continued follow-up.,We conducted a prospective observational study of unaffected BRCA mutation carriers to evaluate adherence to MMG screening recommendations. Women undergoing BRCA1/2 testing between 6/1/1995 and 12/31/2003 were enrolled in IRB-approved prospective follow-up studies. Screening performed prior to testing was determined by questionnaire at the time of enrollment. Patients were followed annually with structured questionnaires and medical records review. Participation in MMG screening and reported frequency of MMG screening at baseline and last follow-up were compared using the Wilcoxon signed-rank and Fisher's exact tests.,139 unaffected women with breast tissue at risk at the time of genetic testing were followed for a median of 38.3 months. Women who underwent risk-reducing mastectomy (25), developed cancer (13) or did not provide MMG information (5) were excluded. At a median follow-up of 32.0 months, 87 of 96 (90.6%) remaining women reported MMG screening within 12 months of their most recent questionnaire. Of 46 women aged <40 at genetic testing, 84.8% (39) described MMG within 12 months, compared with 96.0% of women 40 or older (P=0.10). Screening uptake after genetic testing in the 86 women providing both baseline and follow-up information increased from 73.3% to 96.5% (p<0.0001). In women under age 40 at testing (40), screening increased from 52.5% to 92.5% (p<0.001). Average annual MMG frequency increased from 0.76 to 1.12 (p<0.0001) in all women and from 0.53 to 1.03 (p<0.0001) in women <40.,We found a significant increase in adherence to MMG screening recommendations after risk assessment and counseling which persisted for a median of 32 months. In our experience, adherence was not significantly reduced in younger women. No significant financial relationships to disclose.