Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition
Mieke Kriege, M.Sc., Cecile T.M. Brekelmans, M.D., Ph.D., Carla Boetes, M.D., Ph.D., Peter E. Besnard, M.D., Ph.D., Harmine M. Zonderland, M.D., Ph.D., Inge Marie Obdeijn, M.D., Radu A. Manoliu, M.D., Ph.D., Theo Kok, M.D., Ph.D., Hans Peterse, M.D., Madeleine M.A. Tilanus-Linthorst, M.D., Sara H. Muller, M.D., Ph.D., Sybren Meijer, M.D., Ph.D., Jan C. Oosterwijk, M.D., Ph.D., Louk V.A.M. Beex, M.D., Ph.D., Rob A.E.M. Tollenaar, M.D., Ph.D., Harry J. de Koning, M.D., Ph.D., Emiel J.T. Rutgers, M.D., Ph.D., Jan G.M. Klijn, M.D., Ph.D., for the Magnetic Resonance Imaging Screening Study Group
Background The value of regular surveillance for breast cancerin women with a genetic or familial predisposition to breastcancer is currently unproven. We compared the efficacy of magneticresonance imaging (MRI) with that of mammography for screeningin this group of high-risk women.
Methods Women who had a cumulative lifetime risk of breast cancerof 15 percent or more were screened every six months with aclinical breast examination and once a year by mammography andMRI, with independent readings. The characteristics of the cancersthat were detected were compared with the characteristics ofthose in two different age-matched control groups.
Results We screened 1909 eligible women, including 358 carriersof germ-line mutations. Within a median follow-up period of2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomasin situ, and 1 lymphoma) and 1 lobular carcinoma in situ weredetected. 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 specificitywas 98.1 percent, 95.0 percent, and 89.8 percent, respectively.The overall discriminating capacity of MRI was significantlybetter than that of mammography (P<0.05). The proportionof invasive tumors that were 10 mm or less in diameter was significantlygreater in our surveillance group (43.2 percent) than in eithercontrol group (14.0 percent [P<0.001] and 12.5 percent [P=0.04],respectively). The combined incidence of positive axillary nodesand micrometastases in invasive cancers in our study was 21.4percent, as compared with 52.4 percent (P<0.001) and 56.4percent (P=0.001) in the two control groups.
From the Rotterdam Family Cancer Clinic, Department of Medical Oncology (M.K., C.T.M.B., J.G.M.K.), and the Departments of Radiology (I.M.O.) and Surgery (M.M.A.T.-L.), Erasmus Medical Center–Daniel den Hoed Cancer Center, Rotterdam; the Department of Radiology (C.B.) and the Department of Medical Oncology and Family Cancer Clinic (L.V.A.M.B.), University Medical Center Nijmegen, Nijmegen; the Departments of Radiology (P.E.B., S.H.M.), Pathology (H.P.), and Surgery (E.J.T.R.), Netherlands Cancer Institute, Amsterdam; the Departments of Radiology (H.M.Z.) and Surgery (R.A.E.M.T.), Leiden University Medical Center, Leiden; the Departments of Radiology (R.A.M.) and Surgery (S.M.), Free University Medical Center, Amsterdam; the Departments of Radiology (T.K.) and Clinical Genetics (J.C.O.), University Hospital Groningen, Groningen; and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) — all in the Netherlands.
Address reprint requests to Dr. Klijn at Erasmus Medical Center–Daniel den Hoed Cancer Center, Groene Hilledijk 301 3075 EA, Rotterdam, the Netherlands, or at j.g.m.klijn{at}erasmusmc.nl.
MRI in Breast Cancer
Altundag K., Morandi P., Altundag O., Gur D., Kriege M., Brekelmans C. T.M., Klijn J. G.M.
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N Engl J Med 2004;
351:2235-2236, Nov 18, 2004.
Correspondence
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