title: Five-year analysis of magnetic resonance imaging as a screening tool in women at hereditary risk of breast cancer.
abstract: BACKGROUND
  Women at very high risk of breast cancer are recommended to undertake enhanced surveillance with annual MRI in addition to mammography. We aimed to review the performance of breast MRI as a screening modality over its first 5 years at our institution.
  
  
  METHODS
  The study used a retrospective review using prospectively collected data from a consecutive series of women at high risk of developing breast cancer undergoing surveillance MRI.
  
  
  RESULTS
  Two hundred twenty-three women had at least one screening MRI. The median age was 42 years old. Sixty-nine (30.9%) were confirmed genetic mutation carriers. The remaining 154 (69.1%) women were classified as high risk based on family history, without a confirmed genetic mutation. Three hundred forty screening MRI studies were performed. Of these, 69 patients (20.3%) were recalled for further assessment. There was a significant reduction in the recall rate throughout the study for prevalent screens, from 50% (17/34) in 2008 to 14% (9/54) in 2011 (P = 0.004). The overall biopsy rate was 39 in 340 screens (11.5%). Four cancers were identified. Three were in confirmed BRCA1/BRCA2 mutation carriers, and one was found to be a carrier after the cancer was diagnosed. All four were identified as suspicious on MRI, with two having normal mammography. The cancer detection rate of MRI was 1.2% (4/340 screens). The overall positive predictive value was 7.0%, 6.7% for prevalent screens and 7.1% for subsequent screens.
  
  
  CONCLUSIONS
  Breast MRI as a screening modality for malignant lesions in women with high hereditary risk is valuable. The recall rate, especially in the prevalent round, improved with radiologist experience.
authors.affiliation: The Breast Service, The Royal Melbourne and The Royal Women's Hospitals, Melbourne, Victoria, Australia.
authors.forename: Jeffrey K P
authors.initials: JK
authors.lastname: Kam
authors.forename: Paayal
authors.initials: P
authors.lastname: Naidu
authors.forename: Allison K
authors.initials: AK
authors.lastname: Rose
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005819:Genetic Markers / Q000235:genetics*; D020022:Genetic Predisposition to Disease / Q000453:epidemiology* / Q000235:genetics*; D006579:Heterozygote; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology
chemical_list: D005819:Genetic Markers
keywords: breast; cancer; imaging; magnetic; screening