title: MRI breast screening in high-risk women: cancer detection and survival analysis.
abstract: Women with a genetic predisposition to breast cancer tend to develop the disease at a younger age with denser breasts making mammography screening less effective. The introduction of magnetic resonance imaging (MRI) for familial breast cancer screening programs in recent years was intended to improve outcomes in these women. We aimed to assess whether introduction of MRI surveillance improves 5- and 10-year survival of high-risk women and determine the accuracy of MRI breast cancer detection compared with mammography-only or no enhanced surveillance and compare size and pathology of cancers detected in women screened with MRI + mammography and mammography only. We used data from two prospective studies where asymptomatic women with a very high breast cancer risk were screened by either mammography alone or with MRI also compared with BRCA1/2 carriers with no intensive surveillance. 63 cancers were detected in women receiving MRI + mammography and 76 in women receiving mammography only. Sensitivity of MRI + mammography was 93 % with 63 % specificity. Fewer cancers detected on MRI were lymph node positive compared to mammography/no additional screening. There were no differences in 10-year survival between the MRI + mammography and mammography-only groups, but survival was significantly higher in the MRI-screened group (95.3 %) compared to no intensive screening (73.7 %; p = 0.002). There were no deaths among the 21 BRCA2 carriers receiving MRI. There appears to be benefit from screening with MRI, particularly in BRCA2 carriers. Extended follow-up of larger numbers of high-risk women is required to assess long-term survival.
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK, gareth.evans@cmft.nhs.uk.
authors.forename: Evans D
authors.initials: ED
authors.lastname: Gareth
authors.forename: Nisha
authors.initials: N
authors.lastname: Kesavan
authors.forename: Kesavan
authors.initials: K
authors.lastname: Nisha
authors.forename: Yit
authors.initials: Y
authors.lastname: Lim
authors.forename: Lim
authors.initials: L
authors.lastname: Yit
authors.forename: Soujanye
authors.initials: S
authors.lastname: Gadde
authors.forename: Gadde
authors.initials: G
authors.lastname: Soujanye
authors.forename: Emma
authors.initials: E
authors.lastname: Hurley
authors.forename: Hurley
authors.initials: H
authors.lastname: Emma
authors.forename: Nathalie J
authors.initials: NJ
authors.lastname: Massat
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Maxwell
authors.forename: Sarah
authors.initials: S
authors.lastname: Ingham
authors.forename: Ingham
authors.initials: I
authors.lastname: Sarah
authors.forename: Rosalind
authors.initials: R
authors.lastname: Eeles
authors.forename: Eeles
authors.initials: E
authors.lastname: Rosalind
authors.forename: Martin O
authors.initials: MO
authors.lastname: Leach
authors.forename: Anthony
authors.initials: A
authors.lastname: Howell
authors.forename: Howell
authors.initials: H
authors.lastname: Anthony
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Duffy
authors.forename: Duffy
authors.initials: D
authors.lastname: Stephen
mesh_terms: D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000401:mortality; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human