The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers

Abstract

Purpose BRCA2 mutation carriers are offered annual breast screening with MRI and mammography. The aim of this study was to investigate the supplemental value of mammographic screening over MRI screening alone. Methods In this multicenter study, proven BRCA2 mutation carriers, who developed breast cancer during screening using both digital mammography and state-of-art breast MRI, were identified. Clinical data were reviewed to classify cases in screen-detected and interval cancers. Imaging was reviewed to assess the diagnostic value of mammography and MRI, using the Breast Imaging and Data System (BI-RADS) classification allocated at the time of diagnosis. Results From January 2003 till March 2019, 62 invasive breast cancers and 23 ductal carcinomas in situ were diagnosed in 83 BRCA2 mutation carriers under surveillance. Overall screening sensitivity was 95.2% (81/85). Four interval cancers occurred (4.7% (4/85)). MRI detected 73 of 85 breast cancers (sensitivity 85.8%) and 42 mammography (sensitivity 49.9%) (p < 0.001). Eight mammography-only lesions occurred. In 1 of 17 women younger than 40 years, a 6-mm grade 3 DCIS, retrospectively visible on MRI, was detected with mammography only in a 38-year-old woman. The other 7 mammography-only breast cancers were diagnosed in women aged 50 years and older, increasing sensitivity in this subgroup from 79.5% (35/44) to 95.5% (42/44) (p ≤ 0.001). Conclusions In BRCA2 mutation carriers younger than 40 years, the benefit of mammographic screening over MRI was very small. In carriers of 50 years and older, mammographic screening contributed significantly. Hence, we propose to postpone mammographic screening in BRCA2 mutation carriers to at least age 40.

The Usefulness of Spectral Mammography in Surgical Planning of Breast Cancer Treatment—Analysis of 999 Patients with Primary Operable Breast Cancer

“…Magnetic resonance imaging has been proven to have higher sensitivity in detecting neoplastic lesions than digital mammography and ultrasound [ 38 , 39 ]. Research shows that even 14–16% of tumors visible in MRI may remain invisible in MG, and multifocal tumors visualized in MRI and not diagnosed in mammography are often invasive cancers smaller than 10 mm [ 40 , 41 ]. Using MRI in the preoperative diagnostics of breast cancer patients results in modification of the treatment method in every fifth patient [ 41 , 42 , 43 ].…”

“…Research shows that even 14–16% of tumors visible in MRI may remain invisible in MG, and multifocal tumors visualized in MRI and not diagnosed in mammography are often invasive cancers smaller than 10 mm [ 40 , 41 ]. Using MRI in the preoperative diagnostics of breast cancer patients results in modification of the treatment method in every fifth patient [ 41 , 42 , 43 ]. The decision change rate concerning the planned treatment in our study after CESM amounted to 20%.…”

Automated Breast Ultrasound

“…MRI screening has demonstrated to be highly sensitive when detecting breast cancers in women with BRCA1 and BRCA2 gene mutations, with sensitivity amounting to 93.6% [25]. This was further confirmed by Obdeijn et al, a study which concluded that the diagnostic contribution in high-risk women using MRI screening was much higher than using a mammogram [26].…”

12‐year review of MRI‐detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14‐gauge core biopsy?

“…Following the pioneering trials of MRI‐screening in high‐risk populations from the late 1990s, the American Cancer Society first recommended the use of MRI as an adjunct to annual mammography in women with 20–25% or greater life‐time risk in 2007 1 . In 2010, the landmark EVA Trial called into question whether the additional small yield from x‐ray mammography was justified, and subsequent studies have confirmed the efficacy of breast MRI as a stand‐alone method with many centres now advocating limited use of mammography, particularly in young mutation carriers 2–6 . A recent review article noted that MRI had around double the sensitivity of mammography and that ultrasound had no supplemental screening value 7 .…”

“…1 In 2010, the landmark EVA Trial called into question whether the additional small yield from x-ray mammography was justified, and subsequent studies have confirmed the efficacy of breast MRI as a stand-alone method with many centres now advocating limited use of mammography, particularly in young mutation carriers. [2][3][4][5][6] A recent review article noted that MRI had around double the sensitivity of mammography and that ultrasound had no supplemental screening value. 7 The authors also observed that MRI preferentially detects more aggressive types of breast cancer and concluded 'this performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental', citing an estimated 5% additional cancer yield from mammography, mostly DCIS.…”