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Previous Volume 351:427-437 July 29, 2004 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Liberman, L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background 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.

Methods 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.

Results 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.

Conclusions MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

Source Information

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.

Full Text of this Article

Related Letters:

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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