Factors affecting sensitivity and specificity of screening mammography and MRI in women with an inherited risk for breast cancer.
BACKGROUND
The MRISC study is a screening study, in which women with an increased risk of hereditary breast cancer are screened by a yearly mammography and MRI, and half-yearly clinical breast examination. The sensitivity found in this study was 40% for mammography and 71% for MRI and the specificity was 95 and 90%, respectively. In the current subsequent study we investigated whether these results are influenced by age, a BRCA1/2 mutation, menopausal status and breast density.


METHODS
From November 1999 to October 2003, 1909 eligible women were screened and 50 breast cancers were detected. For the current analysis, data of 4134 screening rounds and 45 detected breast cancers were used. For both imaging modalities, screening parameters, receiver operating characteristic (ROC) curves and uni- and multivariate odds ratios (ORs) were calculated. All analyses were separately performed for age at entry (< 40, 40-49, > or =50), mutation status, menopausal status and breast density.


RESULTS
Sensitivity of MRI was decreased in women with high breast density (adjusted OR 0.08). False-positive rates of both mammography (OR(adj) 1.67) and MRI (OR(adj) 1.21) were increased by high breast density, that of MRI by pre-menopausal status (OR(adj) 1.70), young age (OR(adj) 1.58 for women 40-49 years versus women > or =50 years) and decreased in BRCA1/2 mutation carriers (OR(adj) 0.74). In all investigated subgroups the discriminating capacity (measured by the area under the ROC-curve) was higher for MRI than for mammography, with the largest differences for BRCA1/2 mutation carriers (0.237), for women between 40 and 49 years (0.227) and for women with a low breast density (0.237).


CONCLUSIONS
This report supports the earlier recommendation that MRI should be a standard screening method for breast cancer in BRCA1/2 mutation carriers.
Kriege
Mieke
M
Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands.
Brekelmans
Cecile T M
CT
Obdeijn
Inge Marie
IM
Boetes
Carla
C
Zonderland
Harmine M
HM
Muller
Sara H
SH
Kok
Theo
T
Manoliu
Radu A
RA
Besnard
A Peter E
AP
Tilanus-Linthorst
Madeleine M A
MM
Seynaeve
Caroline
C
Bartels
Carina C M
CC
Kaas
Reini
R
Meijer
Siebren
S
Oosterwijk
Jan C
JC
Hoogerbrugge
Nicoline
N
Tollenaar
Rob A E M
RA
Rutgers
Emiel J T
EJ
de Koning
Harry J
HJ
Klijn
Jan G M
JG
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics / Q000473:pathology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity