Kriege M, Brekelmans CTM, Boetes C, et al: Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N Eng J Med 2004;351(5):427-37.
Liberman L: Breast cancer screening with MRI-what are the data for patients at high risk? N Engl J Med 2004;351(5):497-500 (editorial).
The authors report a prospective non-randomized study of screening every 6 months with clinical breast examination, mammography, and magnetic resonance imaging (MRI) in women who had a genetic or familial predisposition to breast cancer (lifetime risk >=15%) in the Netherlands. In all, 1,909 eligible women, including 358 carriers of germ-line mutation, were screened with a median follow-up of 3 years during which time 51 tumors were detected. Among 45 cancers for which complete data was available for analysis, 49% were identified by MRI but not mammography, 22% were identified by both MRI and mammography, and 18% were identified by mammography but not MRI. In this population, MRI compared with mammography had higher sensitivity (71% versus 40%) but lower specificity (90% versus 95%). MRI can detect otherwise hidden breast cancer in high-risk patients and is probably most beneficial in women with the highest risk, where specificity can be sacrificed to gain higher sensitivity. No data support the use of MRI in screening women at normal risk. The role of ultrasonography was not investigated.