title: Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review.
abstract: OBJECTIVE
  In July 2011, the provincial government of Ontario, Canada, approved funding for the addition of annual breast MRI to mammography screening for all women 30-69 years old considered to be at high risk for breast cancer. The purpose of this study was to evaluate the diagnostic performance of screening breast MRI as compared with mammography in a population-based high-risk screening program.
  
  
  METHODS
  A retrospective review identified 650 eligible high-risk women who underwent screening breast MRI and mammography between July 2011 and January 2013 at one institution. Results of 806 screening rounds (comprising both MRI and mammography) were reviewed.
  
  
  RESULTS
  Malignancy was diagnosed in 13 patients (invasive cancer in nine, ductal carcinoma in situ in three [one with microinvasion], and chest wall metastasis in one). Of the 13 cancers, 12 (92.3%) were detected by MRI and four (30.8%) by mammography. In nine of these patients, the cancer was diagnosed by MRI only, resulting in an incremental cancer detection rate of 10 cancers per 1000 women screened. MRI screening had significantly higher sensitivity than mammography (92.3% vs 30.8%) but lower specificity (85.9% vs 96.8%). MRI also resulted in a higher callback rate for a 6-month follow-up study (BI-RADS category 3 assessment) than mammography (119 [14.8%] vs 13 [1.6%]) and more image-guided biopsies than mammography (95 [11.8%] vs 19 [2.4%]).
  
  
  CONCLUSIONS
  MRI is a useful adjunct to mammography for screening in high-risk women, resulting in a significantly higher rate of cancer detection. However, this was found to be at the cost of more imaging and biopsies for lesions that ultimately proved to be benign.
authors: 1 Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada antony.raikhlin@gmail.com
authors: Antony
authors: A
authors: Raikhlin
authors: Belinda
authors: B
authors: Curpen
authors: Ellen
authors: E
authors: Warner
authors: Carrie
authors: C
authors: Betel
authors: Barbara
authors: B
authors: Wright
authors: Roberta
authors: R
authors: Jong
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: BRCA1, BRCA2; breast MRI; breast cancer; high-risk screening; mammography