Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer

Tomasz Huzarski,Ewa Kilar,Robert Sibilski,Barbara Górecka-Szyld,Grażyna Wilk,Jan Lubiński,Monika Siołek,Grażyna Psut-Muszyńska,D Czudowska ,Beata Kozak‐Klonowska ,Cezary Cybulski,Andrzej Maćkiewicz ,Joanna Jarkiewicz‐Tretyn ,Jacek Gronwald,Jowita Huzarska,Hanna Janiszewska,Jadwiga Szabo-Moskal,Dariusz Godlewski,Steven A Narod

doi:10.1186/s13053-017-0064-y

Abstract

BackgroundThe 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.MethodsTwo 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 a CHEK2 mutation, 370 women had a first-degree relative with breast cancer (and no CHEK2 mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination.ResultsTwenty-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.ConclusionsIn 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.

Highlights

The addition of magnetic resonance imaging (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
Several studies have demonstrated that annual magnetic resonance imaging (MRI) is a more sensitive means of screening for breast cancer than annual mammography for women at high risk of cancer [1,2,3,4,5,6,7,8,9,10]
Most cancers in non-carriers or in CHEK2 carriers are ERpositive [11] whereas cancers in BRCA1 carriers are usually triple-negative [12] and these are relatively aggressive in their natural history [13]

Summary

Introduction

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. Several studies have demonstrated that annual magnetic resonance imaging (MRI) is a more sensitive means of screening for breast cancer than annual mammography for women at high risk of cancer [1,2,3,4,5,6,7,8,9,10]. These studies have focused on women at high risk of cancer due to a BRCA1 or BRCA2 mutation, or at moderate risk due to a family history. Missense mutations in CHEK2 confer a 1.4 fold increase in breast cancer risk [14]

Methods

Results

Conclusion