Abstract
BackgroundBreast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection and is therefore offered as a screening technique to women at increased risk of developing breast cancer. However, mammography is currently added from the age of 30 without proven benefits. The purpose of this study is to investigate the added cancer detection of mammography when breast MRI is available, focusing on the value in women with and without BRCA mutation, and in the age groups above and below 50 years.MethodsThis retrospective single-center study evaluated 6553 screening rounds in 2026 women at increased risk of breast cancer (1 January 2003 to 1 January 2014). Risk category (BRCA mutation versus others at increased risk of breast cancer), age at examination, recall, biopsy, and histopathological diagnosis were recorded. Cancer yield, false positive recall rate (FPR), and false positive biopsy rate (FPB) were calculated using generalized estimating equations for separate age categories (< 40, 40–50, 50–60, ≥ 60 years). Numbers of screens needed to detect an additional breast cancer with mammography (NSN) were calculated for the subgroups.ResultsOf a total of 125 screen-detected breast cancers, 112 were detected by MRI and 66 by mammography: 13 cancers were solely detected by mammography, including 8 cases of ductal carcinoma in situ. In BRCA mutation carriers, 3 of 61 cancers were detected only on mammography, while in other women 10 of 64 cases were detected with mammography alone. While 77% of mammography-detected-only cancers were detected in women ≥ 50 years of age, mammography also added more to the FPR in these women. Below 50 years the number of mammographic examinations needed to find an MRI-occult cancer was 1427.ConclusionsMammography is of limited added value in terms of cancer detection when breast MRI is available for women of all ages who are at increased risk. While the benefit appears slightly larger in women over 50 years of age without BRCA mutation, there is also a substantial increase in false positive findings in these women.
Highlights
Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection and is offered as a screening technique to women at increased risk of developing breast cancer
In the study of Kuhl et al [10], MRI proved to be the most important contributor to stage reduction. These results show the superiority of breast MRI compared to mammography for the detection of cancers, routine mammography is currently recommended for all women, even at a relatively young age
We did not observe a difference in the grade of ductal carcinoma in situ (DCIS) detected with mammography or MRI (p = 0.436)
Summary
Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection and is offered as a screening technique to women at increased risk of developing breast cancer. In women at increased risk (e.g. those with a germline mutation in the BRCA1 or BRCA2 genes) biennial mammographic screening is insufficient due to low sensitivity and high rates of interval cancers [2,3,4,5]. These women who have a higher-than-average lifetime risk of breast cancer (approximately ≥ 20–25% life time risk (LTR)) are invited to intensified screening programs [6, 7], consisting of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and mammography. Concerns are raised about the risk of radiation-induced cancers in these women, as BRCA mutation carriers have increased susceptibility to radiation [17, 18]
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