Xuan-Anh Phi1, Nehmat Houssami1, Inge-Marie Obdeijn1, Ellen Warner1, Francesco Sardanelli1, Martin O Leach1, Christopher C Riedl1, Isabelle Trop1, Madeleine M A Tilanus-Linthorst1, Rodica Mandel1, Filippo Santoro1, Gek Kwan-Lim1, Thomas H Helbich1, Harry J de Koning1, Edwin R Van den Heuvel1, Geertruida H de Bock2. 1. Xuan-Anh Phi, Edwin R. Van den Heuvel, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Inge-Marie Obdeijn, Madeleine M.A. Tilanus-Linthorst, and Harry J. de Koning, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nehmat Houssami, School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Ellen Warner and Rodica Mandel, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario; Isabelle Trop, Hospital of Montreal, Montreal, Quebec, Canada; Francesco Sardanelli, University of Milan School of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan; Filippo Santoro, Istituto Superiore di Sanità, Rome, Italy; Martin O. Leach and Gek Kwan-Lim, Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, London, United Kingdom; and Christopher C. Riedl and Thomas H. Helbich, Medical University Vienna, Vienna, Austria. 2. Xuan-Anh Phi, Edwin R. Van den Heuvel, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Inge-Marie Obdeijn, Madeleine M.A. Tilanus-Linthorst, and Harry J. de Koning, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nehmat Houssami, School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Ellen Warner and Rodica Mandel, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario; Isabelle Trop, Hospital of Montreal, Montreal, Quebec, Canada; Francesco Sardanelli, University of Milan School of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan; Filippo Santoro, Istituto Superiore di Sanità, Rome, Italy; Martin O. Leach and Gek Kwan-Lim, Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, London, United Kingdom; and Christopher C. Riedl and Thomas H. Helbich, Medical University Vienna, Vienna, Austria. g.h.de.bock@umcg.nl.
Abstract
PURPOSE: There is no consensus on whether magnetic resonance imaging (MRI) should be included in breast screening protocols for women with BRCA1/2 mutations age ≥ 50 years. Therefore, we investigated the evidence on age-related screening accuracy in women with BRCA1/2 mutations using individual patient data (IPD) meta-analysis. PATIENTS AND METHODS: IPD were pooled from six high-risk screening trials including women with BRCA1/2 mutations who had completed at least one screening round with both MRI and mammography. A generalized linear mixed model with repeated measurements and a random effect of studies estimated sensitivity and specificity of MRI, mammography, and the combination in all women and specifically in those age ≥ 50 years. RESULTS: Pooled analysis showed that in women age ≥ 50 years, screening sensitivity was not different from that in women age < 50 years, whereas screening specificity was. In women age ≥ 50 years, combining MRI and mammography significantly increased screening sensitivity compared with mammography alone (94.1%; 95% CI, 77.7% to 98.7% v 38.1%; 95% CI, 22.4% to 56.7%; P < .001). The combination was not significantly more sensitive than MRI alone (94.1%; 95% CI, 77.7% to 98.7% v 84.4%; 95% CI, 61.8% to 94.8%; P = .28). Combining MRI and mammography in women age ≥ 50 years resulted in sensitivity similar to that in women age < 50 years (94.1%; 95% CI, 77.7% to 98.7% v 93.2%; 95% CI, 79.3% to 98%; P = .79). CONCLUSION: Addition of MRI to mammography for screening BRCA1/2 mutation carriers age ≥ 50 years improves screening sensitivity by a magnitude similar to that observed in younger women. Limiting screening MRI in BRCA1/2 carriers age ≥ 50 years should be reconsidered.
PURPOSE: There is no consensus on whether magnetic resonance imaging (MRI) should be included in breast screening protocols for women with BRCA1/2 mutations age ≥ 50 years. Therefore, we investigated the evidence on age-related screening accuracy in women with BRCA1/2 mutations using individual patient data (IPD) meta-analysis. PATIENTS AND METHODS: IPD were pooled from six high-risk screening trials including women with BRCA1/2 mutations who had completed at least one screening round with both MRI and mammography. A generalized linear mixed model with repeated measurements and a random effect of studies estimated sensitivity and specificity of MRI, mammography, and the combination in all women and specifically in those age ≥ 50 years. RESULTS: Pooled analysis showed that in women age ≥ 50 years, screening sensitivity was not different from that in women age < 50 years, whereas screening specificity was. In women age ≥ 50 years, combining MRI and mammography significantly increased screening sensitivity compared with mammography alone (94.1%; 95% CI, 77.7% to 98.7% v 38.1%; 95% CI, 22.4% to 56.7%; P < .001). The combination was not significantly more sensitive than MRI alone (94.1%; 95% CI, 77.7% to 98.7% v 84.4%; 95% CI, 61.8% to 94.8%; P = .28). Combining MRI and mammography in women age ≥ 50 years resulted in sensitivity similar to that in women age < 50 years (94.1%; 95% CI, 77.7% to 98.7% v 93.2%; 95% CI, 79.3% to 98%; P = .79). CONCLUSION: Addition of MRI to mammography for screening BRCA1/2 mutation carriers age ≥ 50 years improves screening sensitivity by a magnitude similar to that observed in younger women. Limiting screening MRI in BRCA1/2 carriers age ≥ 50 years should be reconsidered.
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