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Open Access 01-06-2020 | Magnetic Resonance Imaging | Clinical trial

The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers

Authors: Inge-Marie Obdeijn, Ritse M. Mann, Claudette C. E. Loo, Marc Lobbes, Eleonora M. C. Voormolen, Carolien H. M. van Deurzen, Geertruida de Bock, Maartje J. Hooning, Hereditary Breast Ovarian Cancer Research Group Netherlands (HEBON)

Published in: Breast Cancer Research and Treatment | Issue 3/2020

Abstract

Purpose

BRCA2 mutation carriers are offered annual breast screening with MRI and mammography. The aim of this study was to investigate the supplemental value of mammographic screening over MRI screening alone.

Methods

In this multicenter study, proven BRCA2 mutation carriers, who developed breast cancer during screening using both digital mammography and state-of-art breast MRI, were identified. Clinical data were reviewed to classify cases in screen-detected and interval cancers. Imaging was reviewed to assess the diagnostic value of mammography and MRI, using the Breast Imaging and Data System (BI-RADS) classification allocated at the time of diagnosis.

Results

From January 2003 till March 2019, 62 invasive breast cancers and 23 ductal carcinomas in situ were diagnosed in 83 BRCA2 mutation carriers under surveillance. Overall screening sensitivity was 95.2% (81/85). Four interval cancers occurred (4.7% (4/85)). MRI detected 73 of 85 breast cancers (sensitivity 85.8%) and 42 mammography (sensitivity 49.9%) (p < 0.001).

Eight mammography-only lesions occurred. In 1 of 17 women younger than 40 years, a 6-mm grade 3 DCIS, retrospectively visible on MRI, was detected with mammography only in a 38-year-old woman. The other 7 mammography-only breast cancers were diagnosed in women aged 50 years and older, increasing sensitivity in this subgroup from 79.5% (35/44) to 95.5% (42/44) (p ≤ 0.001).

Conclusions

In BRCA2 mutation carriers younger than 40 years, the benefit of mammographic screening over MRI was very small. In carriers of 50 years and older, mammographic screening contributed significantly. Hence, we propose to postpone mammographic screening in BRCA2 mutation carriers to at least age 40.

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Title: The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers
Authors: Inge-Marie Obdeijn
Ritse M. Mann
Claudette C. E. Loo
Marc Lobbes
Eleonora M. C. Voormolen
Carolien H. M. van Deurzen
Geertruida de Bock
Maartje J. Hooning
Hereditary Breast Ovarian Cancer Research Group Netherlands (HEBON)
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Breast Cancer
Mammography
Breast Cancer
Breast MRI
Mammography
Published in: Breast Cancer Research and Treatment / Issue 3/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05642-1

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