Breast Cancer Screening for High-Risk Patients of Different Ages and Risk - Which Modality Is Most Effective?

Abstract

While the guidelines for breast cancer screening in average-risk women are well established, screening in high-risk women is not as clear. For women with BRCA1 or BRCA2 mutations, current guidelines recommend screening by clinical breast examination and mammography starting at age 30. For certain high-risk women, additional screening with magnetic resonance imaging (MRI) is encouraged. This review focuses on differentiating imaging modalities used for screening women at high-risk for breast cancer over the age of 50 by discussing the different imaging techniques, cost versus benefit, detection rates, and impact on survival. While mammography is the only imaging modality proven to reduce mortality from breast cancer, MRI is more sensitive in identifying cancers. MRI can often identify smaller malignancies at a greater resolution at an earlier stage. The use of MRI would be more cost effective as there would be less need for invasive therapeutic procedures. Research thus far has not identified an age-specific preference in imaging modality. There are no guidelines for high-risk women that specify screening with respect to age (i.e., older than 50 years old). More research is needed before screening guidelines in different age groups with various risk factors can be established.

The Effects of Q Inside<sup>TM</sup> Safety Technology Micro Transponder on Routine Breast Implant Imaging

“…Although breast MRI has been shown to be effective, it is important to emphasize that breast MRI is not meant to replace mammography [18]. Moreover, the combined use of both modalities has proven to be the most cost-effective choice in some populations [19]. For these reasons, multiple modality assessments should be considered for any woman with or without Motiva Implants® and Q Inside™ Safety Technology.…”

Why the Gold Standard Approach by Mammography Demands Extension by Multiomics? Application of Liquid Biopsy miRNA Profiles to Breast Cancer Disease Management

“…Women with a history of chest wall radiation (i.e., mantle radiation for treatment of Hodgkin's lymphoma) at age 30 or younger have an annual mammography and breast screening MRI starting 5 to 10 years after radiation given, but starting no earlier than age 25 and no later than age 40. For women with BRCA1 or BRCA2 genes mutations, current guidelines recommend annual screening by clinical breast examination and mammography starting at age 30 [44]. However, these approaches may vary from country to country.…”

“…Therefore, magnetic resonance imaging can be used along with mammography in these women to increase sensitivity of the screening program. Regarding the high-risk individuals with BRCA1 or BRCA2 mutations, current guidelines suggest to begin annual MRI imaging at age 25 and to add mammography at age 30 [44]. Recent meta-analysis of Phi et al [62] showed that additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers.…”

Personalised Medicine and Medical Imaging: Opportunities and Challenges for Contemporary Health Care

“…This is exemplified in breast, lung, and colorectal cancer screening programs [39][40][41]. In addition, the use of MRI as a supplemental imaging modality for women at high risk of breast cancer has been found to be very effective in detection even though latest studies suggests its uptake is not as high as expected [42,43]. Screening, as it is today (eg, breast and AAA screening) is based, at least partly, on the thinking that it is more cost-effective to pick up and treat diseases sooner than later in the targeted population.…”