Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition

Leiden University, Leyden, South Holland, Netherlands
New England Journal of Medicine (Impact Factor: 55.87). 07/2004; 351(5):427-37. DOI: 10.1056/NEJMoa031759
Source: PubMed


The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women.
Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different age-matched control groups.
We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P=0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups.
MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

Download full-text


Available from: Rob A E M Tollenaar,
  • Source
    • "A large proportion of BRCA1/2-associated breast cancers detected during adequate surveillance (including breast MRI) is smaller than 1.0 cm (pT1) and node negative [10]. Potentially, routine assessment of tumor-associated inflammation may help improve risk stratification of these early BRCA1/2-associated breast cancers to further personalize (adjuvant) treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prognosis of BRCA1/2-associated breast cancer partly depends on histologic characteristics. Most of these breast cancers, however, are poorly differentiated. BRCA1-associated cancers are mainly negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. Consequently, the use of these histologic features for risk stratification in BRCA1/2 breast cancer is limited. We assessed the prognostic value of additional histologic features, including tumor-associated inflammation and tumor-associated stroma in BRCA1/2 breast cancer patients. From the Rotterdam Family Cancer Clinic database, we collected demographics, tumor characteristics, and follow-up data from female BRCA1/2 breast cancer patients. Tumor samples were centrally reviewed including histologic subtype, differentiation grade, tumor-associated inflammation density, amount of tumor-associated stroma, and intratumor necrosis. The impact of these factors on recurrence-free survival (RFS) was evaluated using univariate and multivariate Cox regression, adjusted for established prognostic features and year of diagnosis. We included 138 BRCA1 and 37 BRCA2 breast cancer patients. Median follow-up after diagnosis was 9.7 years. Independent prognostic factors for RFS were tumor size (hazard ratio [HR], 2.47 for >2 versus ≤2 cm; 95% confidence interval [95% CI], 1.10-5.57), tumor-associated inflammation (HR, 0.18 for moderate/marked versus absent/mild; 95% CI, 0.05-0.61), and intratumor necrosis (HR, 2.60 for presence versus absence; 95% CI, 1.12-6.05). Established prognostic factors as nodal status and differentiation grade were not significantly related to RFS. Subgroup analyses of 138 BRCA1 and 118 triple-negative breast cancer cases showed similar results. Tumor-associated inflammation density was the strongest predictor for RFS in this series of BRCA1/2 breast cancer patients. This provides a potential risk stratification tool that can easily be implemented in routine histologic examination. Copyright © 2014 Elsevier Inc. All rights reserved.
    Human pathology 11/2014; 46(2). DOI:10.1016/j.humpath.2014.10.020 · 2.77 Impact Factor
    • "MM sensitivity (age-and tumour size-dependent) 30p ageo50 50page o90 Kriege et al, 2004; Rijnsburger et al, 2010; Heijnsdijk et al, 2012 Tumour size ¼ "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer. We evaluated the cost-effectiveness of alternative screening strategies involving MRI. Methods: Using a microsimulation model, we generated life histories under different risk profiles, and assessed the impact of screening on quality-adjusted life-years, and lifetime costs, both discounted at 3%. We compared 12 screening strategies combining annual or biennial MRI with mammography and clinical breast examination (CBE) in intervals of 0.5, 1, or 2 years vs without, and reported incremental cost-effectiveness ratios (ICERs). Results: Based on an ICER threshold of $100,000/QALY, the most cost-effective strategy for women at 25% lifetime risk was to stagger MRI and mammography plus CBE every year from age 30 to 74, yielding ICER $58,400 (compared to biennial MRI alone). At 50% lifetime risk and with 70% reduction in MRI cost, the recommended strategy was to stagger MRI and mammography plus CBE every 6 months (ICER=$84,400). At 75% lifetime risk, the recommended strategy is biennial MRI combined with mammography plus CBE every 6 months (ICER=$62,800). Conclusions: The high costs of MRI and its lower specificity are limiting factors for annual screening schedule of MRI, except for women at sufficiently high risk.
    British Journal of Cancer 08/2014; 111(8). DOI:10.1038/bjc.2014.458 · 4.84 Impact Factor
  • Source
    • "MRI is expensive and not widely available to all patients. Moreover, breast MRI suffers from low specificity, which leads to unnecessary biopsies (Kriege et al. 2004; Morris 2001). To overcome these limitations and to enhance the sensitivity and specificity of breast cancer imaging, researchers have examined the utility of new imaging techniques such as elastography (Garra et al. 1997; Plewes et al. 2000; Sharma et al. 2004; Tanter et al. 2008; Zhi et al. 2007), photo-acoustic imaging (Manohar et al. 2005) and diffuse optical tomography (Ntziachristos and Chance 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We previously investigated the application of a novel imaging modality, vibro-acoustography (VA), using an annular confocal transducer (confocal VA) integrated into a clinical prone stereotactic mammography system, to detect various breast abnormalities. To shorten the scanning time and provide improved coverage of the breast, we have evolved our imaging system by implementing VA on a clinical ultrasound scanner equipped with a “quasi-2-D” array transducer. We call this technique “quasi-2-D vibro-acoustography” (Q2-DVA). A clinical ultrasound scanner (GE Vivid 7) was modified to perform both ultrasound imaging and VA using an array transducer consisting of a matrix of 12 rows by 70 columns of ultrasound elements. The newly designed system was used to perform VA on patients with either benign or cancerous lesions. Our results indicate that benign and malignant solid breast lesions were easily detected using our newly modified VA system. It was also possible to detect microcalcifications within the breast. Our results suggest that with further development, Q2-DVA could provide high-resolution diagnostic information in the clinical setting and may be used either as a stand-alone or as a complementary tool in support of other clinical imaging modalities.
    Ultrasound in Medicine & Biology 08/2014; 40(12). DOI:10.1016/j.ultrasmedbio.2014.07.005 · 2.21 Impact Factor
Show more