title: Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer.
abstract: BACKGROUND
  The addition of MRI to mammography and ultrasound for breast cancer screening has been shown to improve screening sensitivity for high risk women, but there is little data to date for women at average or intermediate risk.
  
  
  METHODS
  Two thousand nine hundred and ninety-five women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a screening program, which consisted of two rounds of MRI, ultrasound and mammography, one year apart. Three hundred and fifty-six women had aCHEK2mutation, 370 women had a first-degree relative with breast cancer (and noCHEK2mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination.
  
  
  RESULTS
  Twenty-seven invasive epithelial cancers, one angiosarcoma and six cases of DCIS were identified over the four-year period. Of the 27 invasive cancers, 20 were screen-detected, 2 were interval cancers, and five cancers were identified in the second or third follow-up year (i.e., after the end of the screening period). For invasive cancer, the sensitivity of MRI was 86%, the sensitivity of ultrasound was 59% and the sensitivity of mammography was 50%. The number of biopsies incurred by MRI (n= 156) was greater than the number incurred by mammography (n= 35) or ultrasound (n= 57). Of the 19 invasive cancers detected by MRI, 17 (89%) were also detected by ultrasound or mammography.
  
  
  CONCLUSIONS
  In terms of sensitivity, MRI is slightly better than the combination of mammography and ultrasound for screening of women at average or intermediate risk of breast cancer. However, because of additional costs incurred by MRI screening, and the small gain in sensitivity, MRI screening is probably not warranted outside of high-risk populations.
authors.affiliation: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Huzarski
authors.affiliation: Department of Radiology, Pomeranian Medical University, Szczecin, Poland.|Euro-Medic Diagnostics Poland Ltd, Szczecin, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Górecka-Szyld
authors.affiliation: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jowita
authors.initials: J
authors.lastname: Huzarska
authors.affiliation: Department of Radiology, Pomeranian Medical University, Szczecin, Poland.|Euro-Medic Diagnostics Poland Ltd, Szczecin, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Psut-Muszyńska
authors.affiliation: Department of Radiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Wilk
authors.affiliation: Oncology Diagnostic Center, Zielona Góra, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sibilski
authors.affiliation: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Cybulski
authors.affiliation: Regional Oncology Center, Kielce, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Kozak-Klonowska
authors.affiliation: Regional Oncology Center, Kielce, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Siołek
authors.affiliation: Department of Oncology, District Specialist Hospital, Świdnica, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Kilar
authors.affiliation: Oncology Diagnostic Center, Legnica, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Czudowska
authors.affiliation: Department of Clinical Genetics, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Janiszewska
authors.affiliation: Prophylactic and Epidemiology Cancer Center, Poznań, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Godlewski
authors.affiliation: Department of Cancer Immunology, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznań, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Mackiewicz
authors.affiliation: District Specialist Hospital, Toruń, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Jarkiewicz-Tretyn
authors.affiliation: Department of Radiology, Regional Oncology Hospital, Bydgoszcz, Poland.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Szabo-Moskal
authors.affiliation: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Gronwald
authors.affiliation: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Lubiński
authors.affiliation: Women's College Research Institute, Women's College Hospital and the University of Toronto, 76 Grenville Street, 6th Floor, Toronto, ON M5S 1B2 Canada.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
keywords: Breast cancer; CHEK2; Magnetic resonance imaging; Mammography; Screening; Ultrasound