JCO: MRI screening bests ultrasound, mammography for high-risk patients
MRI screening for women considered to be at high or moderate risk for breast cancer is more effective in the detection of the disease in the early stages than either half-yearly digital ultrasound and/or annual mammography, according to a recent prospective study published online Feb. 22 in the Journal of Clinical Oncology.
The German multicenter cohort study confirmed that MRI is three times more sensitive for breast cancer than digital mammography and suggested that current breast cancer screening guidelines for young women with an increased risk for breast cancer may need to be revised.
Christiane Kuhl, PhD, a radiologist at the University of Bonn in Germany, and colleagues sought to learn the respective contribution of mammography, ultrasound and quality-assured MRI, used alone or in combination for the screening of women at elevated risk for breast cancer.
The investigators recruited 687 women between 2002-2007 who all carried a moderately increased risk of breast cancer (20 percent and greater). The participants underwent 1,679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound exams. The average follow-up period was 29.18 months.
Of the 687 study participants, 27 women were diagnosed with breast cancer, with 11 cases of ductal carcinoma in situ (41percent) and 16 invasive cancers (59 percent). Of the 27 cases, 11 percent were found to be node positive.
The researchers reported cancer yield of ultrasound (six of 1,000 and mammography (5.4 of 1,000) was "equivalent," increasing nonsignificantly (7.7 of 1,000) if both methods were combined. However, cancer yield achieved by MRI alone (14.9 of 1,000) was significantly higher, and it was not significantly improved by adding mammography (MRI plus mammography: 16 of 1,000).
Of all imaging methods under investigation, MRI offered by far the highest sensitivity: MRI identified 93 percent of breast cancers, while 37 percent of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33 percent), according to Kuhl and colleagues.
While current guidelines for women at high risk for breast cancer suggest screening by way of annual mammography (with or without ultrasound) starting at age 25-30, the authors noted that the results of their study could pave the way for these recommendations to change.
In light of the recent discussion of radiation and its potentially negative effects, Kuhl and collegues explained that digital mammography uses ionizing radiation to detect breast cancer, while MRI does not.
"The radiation dose associated with regular mammographic screening is clearly acceptable and safe,” wrote the authors. “However, regular mammographic screening usually starts at age 40-50. The situation is different if systematic annual mammographic screening is started at age 25-30, not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation.”
Based on the study’s findings, Kuhl said: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI.”
The German multicenter cohort study confirmed that MRI is three times more sensitive for breast cancer than digital mammography and suggested that current breast cancer screening guidelines for young women with an increased risk for breast cancer may need to be revised.
Christiane Kuhl, PhD, a radiologist at the University of Bonn in Germany, and colleagues sought to learn the respective contribution of mammography, ultrasound and quality-assured MRI, used alone or in combination for the screening of women at elevated risk for breast cancer.
The investigators recruited 687 women between 2002-2007 who all carried a moderately increased risk of breast cancer (20 percent and greater). The participants underwent 1,679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound exams. The average follow-up period was 29.18 months.
Of the 687 study participants, 27 women were diagnosed with breast cancer, with 11 cases of ductal carcinoma in situ (41percent) and 16 invasive cancers (59 percent). Of the 27 cases, 11 percent were found to be node positive.
The researchers reported cancer yield of ultrasound (six of 1,000 and mammography (5.4 of 1,000) was "equivalent," increasing nonsignificantly (7.7 of 1,000) if both methods were combined. However, cancer yield achieved by MRI alone (14.9 of 1,000) was significantly higher, and it was not significantly improved by adding mammography (MRI plus mammography: 16 of 1,000).
Of all imaging methods under investigation, MRI offered by far the highest sensitivity: MRI identified 93 percent of breast cancers, while 37 percent of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33 percent), according to Kuhl and colleagues.
While current guidelines for women at high risk for breast cancer suggest screening by way of annual mammography (with or without ultrasound) starting at age 25-30, the authors noted that the results of their study could pave the way for these recommendations to change.
In light of the recent discussion of radiation and its potentially negative effects, Kuhl and collegues explained that digital mammography uses ionizing radiation to detect breast cancer, while MRI does not.
"The radiation dose associated with regular mammographic screening is clearly acceptable and safe,” wrote the authors. “However, regular mammographic screening usually starts at age 40-50. The situation is different if systematic annual mammographic screening is started at age 25-30, not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation.”
Based on the study’s findings, Kuhl said: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI.”