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The added value of mammography in different age-groups of women with and without BRCA mutation screened with breast MRI
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The added value of mammography in different age-groups of women with and without BRCA mutation screened with breast MRI
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Journal Article
The added value of mammography in different age-groups of women with and without BRCA mutation screened with breast MRI
2018
Overview
Background
Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection and is therefore offered as a screening technique to women at increased risk of developing breast cancer. However, mammography is currently added from the age of 30 without proven benefits. The purpose of this study is to investigate the added cancer detection of mammography when breast MRI is available, focusing on the value in women with and without
BRCA
mutation, and in the age groups above and below 50 years.
Methods
This retrospective single-center study evaluated 6553 screening rounds in 2026 women at increased risk of breast cancer (1 January 2003 to 1 January 2014). Risk category (
BRCA
mutation versus others at increased risk of breast cancer), age at examination, recall, biopsy, and histopathological diagnosis were recorded. Cancer yield, false positive recall rate (FPR), and false positive biopsy rate (FPB) were calculated using generalized estimating equations for separate age categories (< 40, 40–50, 50–60, ≥ 60 years). Numbers of screens needed to detect an additional breast cancer with mammography (NSN) were calculated for the subgroups.
Results
Of a total of 125 screen-detected breast cancers, 112 were detected by MRI and 66 by mammography: 13 cancers were solely detected by mammography, including 8 cases of ductal carcinoma in situ. In
BRCA
mutation carriers, 3 of 61 cancers were detected only on mammography, while in other women 10 of 64 cases were detected with mammography alone. While 77% of mammography-detected-only cancers were detected in women ≥ 50 years of age, mammography also added more to the FPR in these women. Below 50 years the number of mammographic examinations needed to find an MRI-occult cancer was 1427.
Conclusions
Mammography is of limited added value in terms of cancer detection when breast MRI is available for women of all ages who are at increased risk. While the benefit appears slightly larger in women over 50 years of age without
BRCA
mutation, there is also a substantial increase in false positive findings in these women.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Age
/ Aged
/ Biomedical and Life Sciences
/ Biopsy
/ Breast Neoplasms - diagnostic imaging
/ Breast Neoplasms - pathology
/ Early Detection of Cancer - methods
/ Early Detection of Cancer - statistics & numerical data
/ Female
/ Humans
/ Magnetic Resonance Imaging - statistics & numerical data
/ Mammography - statistics & numerical data
/ Mass Screening - statistics & numerical data
/ Mutation
/ NMR
/ Oncology
/ Screen-detected breast cancer
/ Studies
