Screening high risk women with MRI alone?

Abstract

Breast cancer affects up to 1:7 to 1:11 women in Western countries. Although breast cancer is mainly a sporadic disease, about 15% of cases are clustered in families with highly or moderately elevated incidence. Pathogenic mutations in high-risk genes at autosomic dominant inheritance are held responsible for about 5% of BCs, in which the disease may have early onset, with an estimated cumulative lifetime risk as high as 50% to 85%. About 50% of hereditary BCs can be explained by mutations in BRCA1 and BRCA2 genes [1,2]. In women at high risk of breast cancer, screening mammography has shown a lower sensitivity (29–50%) compared with that of the screening addressed to the general female population (70–80%), with higher percentages of interval cancers (35–50% versus 20–25%) and a higher rate of nodal involvement (20–56% versus 22%) [1,3]. In the last decade a number of prospective, non-randomized studies have been conducted in Europe and North America to assess the value of dynamic contrast-enhanced MRI as a screening tool to be used as an adjunct to mammography, or to mammography plus ultrasonography (US) for the surveillance of women at high geneticfamiliar risk of BC [4–12]. The general result of these studies is that MRI largely outperforms mammography and/or US in detecting breast cancers in asymptomatic high-risk women, as confirmed by reviews and meta-analyses [13–17]. In 2007, on the basis of early evidence available in the literature, the American Cancer Society issued a recommendation in favor