Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition.
BACKGROUND
The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women.


METHODS
Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different age-matched control groups.


RESULTS
We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P=0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups.


CONCLUSIONS
MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.
Kriege
Mieke
M
Rotterdam Family Cancer Clinic, Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Brekelmans
Cecile T M
CT
Boetes
Carla
C
Besnard
Peter E
PE
Zonderland
Harmine M
HM
Obdeijn
Inge Marie
IM
Manoliu
Radu A
RA
Kok
Theo
T
Peterse
Hans
H
Tilanus-Linthorst
Madeleine M A
MM
Muller
Sara H
SH
Meijer
Sybren
S
Oosterwijk
Jan C
JC
Beex
Louk V A M
LV
Tollenaar
Rob A E M
RA
de Koning
Harry J
HJ
Rutgers
Emiel J T
EJ
Klijn
Jan G M
JG
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D012680:Sensitivity and Specificity; D016019:Survival Analysis