Screening women at high risk for breast cancer with mammography and magnetic resonance imaging.
BACKGROUND
The authors compared the performance of screening mammography versus magnetic resonance imaging (MRI) in women at genetically high risk for breast cancer.


METHODS
The authors conducted an international prospective study of screening mammography and MRI in asymptomatic, genetically high-risk women age >/= 25 years. Women with a history of breast cancer were eligible for a contralateral screening if they had been diagnosed within 5 years or a bilateral screening if they had been diagnosed > 5 years previously. All examinations (MRI, mammography, and clinical breast examination [CBE]) were performed within 90 days of each other.


RESULTS
In total, 390 eligible women were enrolled by 13 sites, and 367 women completed all study examinations. Imaging evaluations recommended 38 biopsies, and 27 biopsies were performed, resulting in 4 cancers diagnosed for an overall 1.1% cancer yield (95% confidence interval [95%CI], 0.3-2.8%). MRI detected all four cancers, whereas mammography detected one cancer. The diagnostic yield of mammography was 0.3% (95%CI, 0.01-1.5%). The yield of cancer by MRI alone was 0.8% (95%CI, - 0.3-2.0%). The biopsy recommendation rates for MRI and mammography were 8.5% (95%CI, 5.8-11.8%) and 2.2% (95%CI, 0.1-4.3%).


CONCLUSIONS
Screening MRI in high-risk women was capable of detecting mammographically and clinically occult breast cancer. Screening MRI resulted in 22 of 367 of women (6%) who had negative mammogram and negative CBE examinations undergoing biopsy, resulting in 3 additional cancers detected. MRI also resulted in 19 (5%) false-positive outcomes, which resulted in benign biopsies.
Lehman
Constance D
CD
Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington 98109-1023, USA. lehman@seattlecca.org
Blume
Jeffrey D
JD
Weatherall
Paul
P
Thickman
David
D
Hylton
Nola
N
Warner
Ellen
E
Pisano
Etta
E
Schnitt
Stuart J
SJ
Gatsonis
Constantine
C
Schnall
Mitchell
M
DeAngelis
Gia A
GA
Stomper
Paul
P
Rosen
Eric L
EL
O'Loughlin
Michael
M
Harms
Steven
S
Bluemke
David A
DA
D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis*; D002278:Carcinoma in Situ / Q000175:diagnosis; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis; D018275:Carcinoma, Lobular / Q000175:diagnosis; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity