BACKGROUND: Women genetically predisposed to breast cancer often develop the disease at a young age when dense breast tissue reduces the sensitivity of X-ray mammography. Our aim was, therefore, to compare contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening. METHODS: We did a prospective multicentre cohort study in 649 women aged 35-49 years with a strong family history of breast cancer or a high probability of a BRCA1, BRCA2, or TP53 mutation. We recruited participants from 22 centres in the UK, and offered the women annual screening with CE MRI and mammography for 2-7 years. FINDINGS: We diagnosed 35 cancers in the 649 women screened with both mammography and CE MRI (1881 screens): 19 by CE MRI only, six by mammography only, and eight by both, with two interval cases. Sensitivity was significantly higher for CE MRI (77%, 95% CI 60-90) than for mammography (40%, 24-58; p=0.01), and was 94% (81-99) when both methods were used. Specificity was 93% (92-95) for mammography, 81% (80-83) for CE MRI (p<0.0001), and 77% (75-79) with both methods. The difference between CE MRI and mammography sensitivities was particularly pronounced in BRCA1 carriers (13 cancers; 92%vs 23%, p=0.004). INTERPRETATION: Our findings indicate that CE MRI is more sensitive than mammography for cancer detection. Specificity for both procedures was acceptable. Despite a high proportion of grade 3 cancers, tumours were small and few women were node positive. Annual screening, combining CE MRI and mammography, would detect most tumours in this risk group.
BACKGROUND:Women genetically predisposed to breast cancer often develop the disease at a young age when dense breast tissue reduces the sensitivity of X-ray mammography. Our aim was, therefore, to compare contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening. METHODS: We did a prospective multicentre cohort study in 649 women aged 35-49 years with a strong family history of breast cancer or a high probability of a BRCA1, BRCA2, or TP53 mutation. We recruited participants from 22 centres in the UK, and offered the women annual screening with CE MRI and mammography for 2-7 years. FINDINGS: We diagnosed 35 cancers in the 649 women screened with both mammography and CE MRI (1881 screens): 19 by CE MRI only, six by mammography only, and eight by both, with two interval cases. Sensitivity was significantly higher for CE MRI (77%, 95% CI 60-90) than for mammography (40%, 24-58; p=0.01), and was 94% (81-99) when both methods were used. Specificity was 93% (92-95) for mammography, 81% (80-83) for CE MRI (p<0.0001), and 77% (75-79) with both methods. The difference between CE MRI and mammography sensitivities was particularly pronounced in BRCA1 carriers (13 cancers; 92%vs 23%, p=0.004). INTERPRETATION: Our findings indicate that CE MRI is more sensitive than mammography for cancer detection. Specificity for both procedures was acceptable. Despite a high proportion of grade 3 cancers, tumours were small and few women were node positive. Annual screening, combining CE MRI and mammography, would detect most tumours in this risk group.
Authors: Mandy L Ballinger; Ana Best; Phuong L Mai; Payal P Khincha; Jennifer T Loud; June A Peters; Maria Isabel Achatz; Rubens Chojniak; Alexandre Balieiro da Costa; Karina Miranda Santiago; Judy Garber; Allison F O'Neill; Rosalind A Eeles; D Gareth Evans; Eveline Bleiker; Gabe S Sonke; Marielle Ruijs; Claudette Loo; Joshua Schiffman; Anne Naumer; Wendy Kohlmann; Louise C Strong; Jasmina Bojadzieva; David Malkin; Surya P Rednam; Elena M Stoffel; Erika Koeppe; Jeffrey N Weitzel; Thomas P Slavin; Bita Nehoray; Mark Robson; Michael Walsh; Lorenzo Manelli; Anita Villani; David M Thomas; Sharon A Savage Journal: JAMA Oncol Date: 2017-12-01 Impact factor: 31.777
Authors: Kathryn P Lowry; Janie M Lee; Chung Y Kong; Pamela M McMahon; Michael E Gilmore; Jessica E Cott Chubiz; Etta D Pisano; Constantine Gatsonis; Paula D Ryan; Elissa M Ozanne; G Scott Gazelle Journal: Cancer Date: 2011-09-20 Impact factor: 6.860
Authors: Deirdre A Hill; Jennifer S Haas; Robert Wellman; Rebecca A Hubbard; Christoph I Lee; Jennifer Alford-Teaster; Karen J Wernli; Louise M Henderson; Natasha K Stout; Anna N A Tosteson; Karla Kerlikowske; Tracy Onega Journal: J Gen Intern Med Date: 2017-12-06 Impact factor: 5.128
Authors: Habib Rahbar; Zheng Zhang; Thomas L Chenevert; Justin Romanoff; Averi E Kitsch; Lucy G Hanna; Sara M Harvey; Linda Moy; Wendy B DeMartini; Basak Dogan; Wei T Yang; Lilian C Wang; Bonnie N Joe; Karen Y Oh; Colleen H Neal; Elizabeth S McDonald; Mitchell D Schnall; Constance D Lehman; Christopher E Comstock; Savannah C Partridge Journal: Clin Cancer Res Date: 2019-01-15 Impact factor: 12.531