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Annals of Surgical Oncology

Published in:

01-03-2007

Results of MRI Screening for Breast Cancer in High-Risk Patients with LCIS and Atypical Hyperplasia

Authors: Elisa Rush Port, Anna Park, Patrick I. Borgen, Elizabeth Morris, Leslie L. Montgomery

Published in: Annals of Surgical Oncology | Issue 3/2007

Abstract

Background

Magnetic resonance imaging (MRI) can detect breast cancer in high-risk patients, but is associated with a significant false-positive rate resulting in unnecessary breast biopsies. More data are needed to define the role of MRI screening for specific high-risk groups. We describe our experience with MRI screening in patients with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS).

Methods

We retrospectively reviewed data from our high-risk screening program prospective database for the period from April 1999 (when screening MRI was first performed at our institution) to July 2005. Patients with AH or LCIS demonstrated on previous surgical biopsy were identified. All patients underwent yearly mammography and twice yearly clinical breast examination. Additional screening MRI was performed at the discretion of the physician and patient.

Results

We identified 378 patients; 126 had AH and 252 had LCIS. Of these, 182 (48%) underwent one or more screening MRIs (mean, 2.6 MRIs; range, 1–8) during this period, whereas 196 (52%) did not. Those who had MRIs were younger (P < 0.001) with stronger family histories of breast cancer (P = 0.02). In MRI-screened patients, 55 biopsies were recommended in 46/182 (25%) patients, with 46/55 (84%) biopsies based on MRI findings alone. Cancer was detected in 6/46 (13%) MRI-generated biopsies. None of the six cancers detected on MRI were seen on recent mammogram. All six cancers were detected in five patients (one with bilateral breast cancer) with LCIS; none were detected by MRI in the AH group. Thus, cancer was detected in 5/135 (4%) of patients with LCIS undergoing MRI. The yield of MRI screening overall was cancer detection in 6/46 (13%) biopsies, 5/182 (3%) MRI-screened patients and 5/478 (1%) total MRIs done. In two additional MRI-screened patients, cancer was detected by a palpable mass in one, and on prophylactic surgery in the other and missed by all recent imaging studies. For 196 non-MRI-screened patients, 21 (11%) underwent 22 biopsies during the same period. Eight of 22 (36%) biopsies yielded cancer in seven patients. All MRI-detected cancers were stage 0–I, whereas all non-MRI cancers were stage I–II.

Conclusion

Patients with AH and LCIS selected to undergo MRI screening were younger with stronger family histories of breast cancer. MRI screening generated more biopsies for a large proportion of patients, and facilitated detection of cancer in only a small highly selected group of patients with LCIS.

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56(2):106–130PubMedCrossRef

Satagopan JM, Offit K, Foulkes W, et al. The lifetime risks of breast cancer in Ashkenazi Jewish carriers of BRCA1 and BRCA2 mutations. Cancer Epidemiol Biomarkers Prev 2001; 10(5):467–473PubMed

Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 1989; 81(24):1879–1886PubMedCrossRef

Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985; 312(3):146–151PubMedCrossRef

Page DL, Kidd TE Jr., Dupont WD, et al. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol 1991; 22(12):1232–1239PubMedCrossRef

Aisenberg AC, Finkelstein DM, Doppke KP, et al. High risk of breast carcinoma after irradiation of young women with Hodgkin’s disease. Cancer 1997; 79(6):1203–1210PubMedCrossRef

Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90(18):1371–1388PubMedCrossRef

Morris EA, Liberman L, Ballon DJ, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 2003; 181(3):619–626PubMed

Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351(5):427–437PubMedCrossRef

10.

Kuhl CK. Screening of women with hereditary risk of breast cancer. Clin Breast Cancer 2004; 5:269–271

11.

Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 2005; 365(9473):1769–1778PubMedCrossRef

12.

National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis Guidelines. Clinical Practice Guidelines in Oncology – v.1.2005, 2005; http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf

13.

Kuhl CK, Schmutzler RK, Leutner CC, et al. Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 2000; 215(1):267–279PubMed

14.

Leach MO, Eeles RA, Turnbull LW, et al. The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS). J Exp Clin Cancer Res 2002; 21(3 Suppl):107–114PubMed

15.

Lehman CD, Blume JD, Thickman D, et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 2005; 92(1):9–15; discussion, 15–16PubMedCrossRef

16.

Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 2005; 103(9):1898–1905PubMedCrossRef

17.

Lehman CD, Schnall MD, Kuhl CK, Harms SE. Report of the working groups on breast MRI: report of the High-Risk Screening Group. Breast J 2004; 10(Suppl 2):S9–S12PubMedCrossRef

18.

Podo F, Sardanelli F, Canese R, et al. The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk. J Exp Clin Cancer Res 2002; 21(3 Suppl):115–124PubMed

19.

Tilanus-Linthorst MM, Obdeijn IM, Bartels KC, et al. First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 2000; 63(1):53–60PubMedCrossRef

20.

Morris EA, Liberman L, Dershaw DD, et al. Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 2002; 178(5):1211–1220PubMed

21.

Liberman L, Morris EA, Lee MJ, et al. Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol 2002; 179(1):171–178PubMed

22.

Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst 2001; 93(21):1633–1637PubMedCrossRef

23.

Port ER, Montgomery LL, Heerdt AS, Borgen PI. Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol 2001; 8(7):580–585PubMedCrossRef

24.

Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 Trial. JAMA 2006, Jun 5; Epub ahead of print

25.

Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 1999, Jun 16; 281(23):2189–2197CrossRef

26.

Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353(17):1784–1792PubMedCrossRef

27.

Seidman H, Gelb SK, Silverberg E, et al. Survival experience in the Breast Cancer Detection Demonstration Project. CA Cancer J Clin 1987; 37(5):258–290PubMed

28.

Olson JA Jr., Morris EA, Van Zee KJ, et al. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol 2000; 7(6):411–415PubMedCrossRef

29.

Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 2005; 23(33):8469–8476PubMedCrossRef

30.

Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005; 353(3):229–237PubMedCrossRef

Title: Results of MRI Screening for Breast Cancer in High-Risk Patients with LCIS and Atypical Hyperplasia
Authors: Elisa Rush Port
Anna Park
Patrick I. Borgen
Elizabeth Morris
Leslie L. Montgomery
Publication date: 01-03-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9195-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Results of MRI Screening for Breast Cancer in High-Risk Patients with LCIS and Atypical Hyperplasia

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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