Epidemiology

Breast Cancer Research and Treatment

, Volume 100, Issue 1, pp 109-119

First online:

Factors Affecting Sensitivity and Specificity of Screening Mammography and MRI in Women with an Inherited Risk for Breast Cancer

  • Mieke KriegeAffiliated withFamily Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center
  • , Cecile T. M. BrekelmansAffiliated withFamily Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center
  • , Inge Marie ObdeijnAffiliated withFamily Cancer Clinic, Department of Radiology, Erasmus MC-Daniel den Hoed Cancer Center
  • , Carla BoetesAffiliated withDepartment of Radiology, University Medical Center
  • , Harmine M. ZonderlandAffiliated withDepartment of Radiology, Leiden University Medical Center
  • , Sara H. MullerAffiliated withDepartment of Radiology, Netherlands Cancer Institute
  • , Theo KokAffiliated withDepartment of Radiology, University Medical Center, University of Groningen
  • , Radu A. ManoliuAffiliated withDepartment of Radiology, VU University Medical Center
  • , A. Peter E. BesnardAffiliated withDepartment of Radiology, Netherlands Cancer Institute
    • , Madeleine M. A. Tilanus-LinthorstAffiliated withFamily Cancer Clinic, Department of Surgery, Erasmus MC-Daniel den Hoed Cancer Center
    • , Caroline SeynaeveAffiliated withFamily Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center
    • , Carina C. M. BartelsAffiliated withFamily Cancer Clinic, Department of Surgery, Erasmus MC-Daniel den Hoed Cancer Center
    • , Reini KaasAffiliated withDepartment of Surgery, Netherlands Cancer Institute
    • , Siebren MeijerAffiliated withDepartment of Surgery, VU University Medical Center
    • , Jan C. OosterwijkAffiliated withDepartment of Clinical Genetics, University Medical Center, University of Groningen
    • , Nicoline HoogerbruggeAffiliated withFamily Cancer Clinic, University Medical Center
    • , Rob A. E. M. TollenaarAffiliated withDepartment of Surgery, Leiden University Medical Center
    • , Emiel J. T. RutgersAffiliated withDepartment of Surgery, Netherlands Cancer Institute
    • , Harry J. de KoningAffiliated withDepartment of Public Health, Erasmus MC
    • , Jan G. M. KlijnAffiliated withFamily Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center Email author 

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Abstract

Background

The MRISC study is a screening study, in which women with an increased risk of hereditary breast cancer are screened by a yearly mammography and MRI, and half-yearly clinical breast examination. The sensitivity found in this study was 40% for mammography and 71% for MRI and the specificity was 95 and 90%, respectively. In the current subsequent study we investigated whether these results are influenced by age, a BRCA1/2 mutation, menopausal status and breast density.

Patients and methods

From November 1999 to October 2003, 1909 eligible women were screened and 50 breast cancers were detected. For the current analysis, data of 4134 screening rounds and 45 detected breast cancers were used. For both imaging modalities, screening parameters, receiver operating characteristic (ROC) curves and uni- and multivariate odds ratios (ORs) were calculated. All analyses were separately performed for age at entry (< 40, 40–49, ≥50), mutation status, menopausal status and breast density.

Results

Sensitivity of MRI was decreased in women with high breast density (adjusted OR 0.08). False-positive rates of both mammography (ORadj 1.67) and MRI (ORadj 1.21) were increased by high breast density, that of MRI by pre-menopausal status (ORadj 1.70), young age (ORadj 1.58 for women 40–49 years versus women ≥50 years) and decreased in BRCA1/2 mutation carriers (ORadj 0.74).

In all investigated subgroups the discriminating capacity (measured by the area under the ROC-curve) was higher for MRI than for mammography, with the largest differences for BRCA1/2 mutation carriers (0.237), for women between 40 and 49 years (0.227) and for women with a low breast density (0.237).

Conclusions

This report supports the earlier recommendation that MRI should be a standard screening method for breast cancer in BRCA1/2 mutation carriers.

Key words

Age BRCA1 BRCA2 Breast cancer screening Breast density Mammography Menopausal status MRI Sensitivity Specificity