Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer

Abstract

; for the Breast Cancer Surveillance Consortium IMPORTANCE There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC). OBJECTIVE To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013. EXPOSURES A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days). MAIN OUTCOMES AND MEASURES Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC. RESULTS We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk. CONCLUSIONS AND RELEVANCE Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.

Surveillance for second breast cancer events in women with a personal history of breast cancer using breast MRI: a systematic review and meta-analysis

“…However, in 2018, the American College of Radiology recommended women with PHBC diagnosed < 50 years or with dense breast tissue should receive annual breast MRI [57]. Women with PHBC who undergo surveillance MRI have been shown to experience higher biopsy rates and significantly lower cancer yield compared to mammography alone [10,58]. The previous systematic review on this topic by Quinn et al stated the limited clinical value of a positive MRI result in this study population due to the need to additional follow-up [11].…”

Trends in screening breast magnetic resonance imaging use among US women, 2006 to 2016

“…[1][2][3] Screening breast MRI has improved sensitivity and cancer detection rates for these subgroups of women 4 ; however, the use of breast MRI to screen for breast cancer can lead to more false-positive results requiring biopsy. 5,6 Early studies of the changes in clinical practice as a result of these guidelines detected a rapid rise in the use of breast MRI prior to initial guideline recommendations by the American Cancer Society (ACS) in 2007, with a plateau in use through 2012. 2,5,7 In national data from the Breast Cancer Surveillance Consortium, rates of screening breast MRI increased >4-fold between 2005 and 2007 from 8 to 34 examinations per 10,000 women and then remained fairly stable at 43 breast MRI examinations per 10,000 women until 2009.…”

“…As an example, since 2007, leading professional and advocacy organizations have recommended screening breast magnetic resonance imaging (MRI) as an adjunct to routine mammography beginning at ages 25 to 30 years among women with a high familial breast cancer risk (>20%‐25%), genetic mutation carriers (ie, BRCA 1/2 carriers), and those with a personal history with chest irradiation 1‐3 . Screening breast MRI has improved sensitivity and cancer detection rates for these subgroups of women 4 ; however, the use of breast MRI to screen for breast cancer can lead to more false‐positive results requiring biopsy 5,6 …”

Local staging of ipsilateral breast tumor recurrence: mammography, ultrasound, or MRI?

“…Furthermore, MRI has a higher sensitivity in comparison to XMG and US for the detection of multifocal lesions in primary breast cancer, i.e., the presence of two or more separate tumor foci in the breast, but it is at the expense of a higher false-positive rate [10]. As a result, more biopsies are being performed when MRI is added to XMG and US [11]. The presence of multifocality is associated with a higher local recurrence rate and worse overall survival [12].…”