The American Cancer Society (ACS) guidelines currently recommend annual screening with breast MRI for women with a known gene mutation or a strong family history indicating a lifetime risk of breast cancer greater than 20%. But there is insufficient evidence for MRI screening in women who have a personal history of breast cancer, according to the guidelines.
A new study, however, found that breast MRI screening is highly accurate in this patient population.
"In our study using breast MRI screening, we actually detected proportionally more cancers in women with a personal history of breast cancer, compared with those women with a genetic mutation or strong family history who are currently recommended to have breast MRI," said Wendy DeMartini, MD, an assistant professor of radiology at the University of Washington Medical Center and Seattle Cancer Care Alliance in Seattle. "Further, women with a personal history were less likely to be recalled for additional testing and less likely to have a biopsy for a false-positive MRI finding."
DeMartini and colleagues performed a retrospective review of initial screening breast MRI exams of 1,026 women from January 2004 to June 2009. Of the 1,026 women, 327 had a genetic or family history of breast cancer and 646 had a personal history of treated breast cancer.
Overall, MRI screening identified 25 of 27 cancers in the group for sensitivity of 92.6%.
The cancer yield in the women with a personal history of breast cancer was 3.1%, double that of the women with a genetic or family history at 1.5%. Specificity in women with a personal history was 93.6%, compared with 86.3% for the other group.
In the group with a personal history of breast cancer, biopsy was recommended in 9.3% of the women, compared with 15% of the genetic and family history group. The positive predictive value of biopsy was also higher in the personal history group, with 35.7% of biopsies yielding cancer, compared with only 12.2% in the other group.
"Our findings show that the diagnostic performance of MRI in patients with a personal history of treated breast cancer supports consideration of screening MRI as an adjunct to mammography," DeMartini concluded. "Additional studies such as ours are necessary to establish guidelines for screening this important group of women."
Breast MRI improves survival rates for at-risk women, November 17, 2010
Breast MRI excels at high-risk screening; mammo not needed, February 26, 2010
MRI plus film-screen mammo screening works for BRCA1 carriers, February 23, 2010
MRI, mammo help early breast cancer detection, December 9, 2009
MR imaging detects breast cancer in those at high risk, March 8, 2007
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