title: Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density.
abstract: OBJECTIVE
  To evaluate the breast cancer screening efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) in a high-risk population and in various population subgroups.
  
  
  METHODS
  In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with a high familial risk (> 20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months. Diagnostic performance was compared between individual modalities and their combinations. Further comparisons were based on subpopulations dichotomized by screening rounds, mutation status, age, and breast density.
  
  
  RESULTS
  There were 559 women with 1,365 complete imaging rounds included in this study. The sensitivity of MRI (90.0%) was significantly higher (P < .001) than that of mammography (37.5%) and ultrasound (37.5%). Of 40 cancers, 18 (45.0%) were detected by MRI alone. Two cancers were found by mammography alone (a ductal carcinoma in situ [DCIS] with microinvasion and a DCIS with < 10-mm invasive areas). This did not lead to a significant increase of sensitivity compared with using MRI alone (P = .15). No cancers were detected by ultrasound alone. Similarly, of 14 DCISs, all were detected by MRI, whereas mammography and ultrasound each detected five DCISs (35.7%). Age, mutation status, and breast density had no influence on the sensitivity of MRI and did not affect the superiority of MRI over mammography and ultrasound.
  
  
  CONCLUSIONS
  MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY. christopher.riedl@medunwien.ac.at.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Riedl
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Luft
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Clemens
authors.initials: C
authors.lastname: Bernhart
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Maria
authors.initials: M
authors.lastname: Bernathova
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Muy-Kheng M
authors.initials: MK
authors.lastname: Tea
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Rudas
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Singer
authors.affiliation: All authors: Medical University of Vienna, Vienna, Austria; and Christopher C. Riedl, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009098:Multiphasic Screening / Q000379:methods*; D009154:Mutation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025521:Tumor Suppressor Proteins; D043222:Ubiquitin Thiolesterase; D014463:Ultrasonography / Q000379:methods*
chemical_list: C575444:BAP1 protein, mouse; D019313:BRCA1 Protein; D024682:BRCA2 Protein; D025521:Tumor Suppressor Proteins; D043222:Ubiquitin Thiolesterase