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MRI breast screening in high-risk women: cancer detection and survival analysis

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An Erratum to this article was published on 09 September 2014

Abstract

Women with a genetic predisposition to breast cancer tend to develop the disease at a younger age with denser breasts making mammography screening less effective. The introduction of magnetic resonance imaging (MRI) for familial breast cancer screening programs in recent years was intended to improve outcomes in these women. We aimed to assess whether introduction of MRI surveillance improves 5- and 10-year survival of high-risk women and determine the accuracy of MRI breast cancer detection compared with mammography-only or no enhanced surveillance and compare size and pathology of cancers detected in women screened with MRI + mammography and mammography only. We used data from two prospective studies where asymptomatic women with a very high breast cancer risk were screened by either mammography alone or with MRI also compared with BRCA1/2 carriers with no intensive surveillance. 63 cancers were detected in women receiving MRI + mammography and 76 in women receiving mammography only. Sensitivity of MRI + mammography was 93 % with 63 % specificity. Fewer cancers detected on MRI were lymph node positive compared to mammography/no additional screening. There were no differences in 10-year survival between the MRI + mammography and mammography-only groups, but survival was significantly higher in the MRI-screened group (95.3 %) compared to no intensive screening (73.7 %; p = 0.002). There were no deaths among the 21 BRCA2 carriers receiving MRI. There appears to be benefit from screening with MRI, particularly in BRCA2 carriers. Extended follow-up of larger numbers of high-risk women is required to assess long-term survival.

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Acknowledgments

We acknowledge support from the NIHR to the Biomedical Research Centre at The Institute of Cancer Research and Royal Marsden NHS Foundation Trust.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Breast Imaging, Nightingale Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK

    Kesavan Nisha, Lim Yit, Gadde Soujanye, Hurley Emma & Anthony J. Maxwell

  2. Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK

    Evans D. Gareth, Kesavan Nisha, Ingham Sarah & Howell Anthony

  3. Manchester University Department of Genomic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St. Mary’s Hospital, Oxford Road, Manchester, M13 9WL, UK

    Evans D. Gareth

  4. Manchester Breast Centre, Manchester Cancer Research Centre, Christie Hospital, University of Manchester, Withington, Manchester, M20 4BX, UK

    Evans D. Gareth & Howell Anthony

  5. Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1 6BQ, UK

    Nathalie J. Massat & Duffy Stephen

  6. CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Martin O. Leach

  7. Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Eeles Rosalind

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  1. Evans D. Gareth
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Consortia

MARIBS Group

Corresponding author

Correspondence to Evans D. Gareth.

Additional information

The members of the MARBIS Group are listed in Appendix.

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Appendix

Appendix

MARIBS study group Study Advisory Group (past and present) MO Leach (Chairman and Principal Investigator, Professor of Physics as Applied to Medicine) J Brown (Health Economist) A Coulthard (Consultant Radiologist) AK Dixon (Professor and Honorary Consultant Radiologist) JM Dixon (Consultant Surgeon and Senior Lecturer) D Easton (Professor of Genetic Epidemiology) RA Eeles (Reader in Clinical Cancer Genetics and Honorary Consultant in Cancer Genetics and Clinical Oncology) DG Evans (Consultant Geneticist) FJ Gilbert (Professor of Radiology) J Hawnaur (Consultant Radiologist) P Kessar (Consultant Radiologist) SR Lakhani (Professor of Breast Cancer Pathology) S Moss (Epidemiologist) A Nerurkar (Consultant Pathologist) AR Padhani (Consultant Radiologist) AJ Potterton (Consultant Radiologist) BAJ Ponder (Professor and Head of Department of Oncology) J Sloane (Professor of Pathology; deceased) LW Turnbull (Professor of Radiology and Honorary Consultant) LG Walker (Professor of Cancer Rehabilitation) RML Warren (Consultant Radiologist) Study Staff (past and present) LJ Pointon (Study Coordinator) RJC Hoff (Assistant Study Coordinator) K Chan (Data Manager) M Khazen (Image Analysis Physicist) RML Warren (Study Radiologist) J Anderson (Health Psychologist)C Levesley (Psychology Research Assistant) I Griebsch (Health Economist) D Thompson (Statistician) C Hayes (Study Physicist) R Gregory (Study Physicist) M Sydenham (Acting Study Coordinator) K Bletcher (Data Manager) GP Liney (Study Physicist) B Browne (Data Manager) Data Monitoring and Ethics Committee K McPherson (Chairman, Visiting Professor of Public Health Epidemiology) R Blamey (Professor Emeritus and Consultant Breast Surgeon) SW Duffy (Professor of Cancer Screening). Trial Steering Committee A Howell (Chairman, Professor of Medical Oncology) D Easton (Study Statistician, Genetic Epidemiologist) DG Evans (Study Representative, Consultant Geneticist) JE Husband (Host Institution Representative, Professor of Radiology) E Maher(Independent Member, Professor of Medical Genetics) MJ Michell (Independent Member, Consultant Radiologist) RML Warren (Study Radiologist, Consultant Radiologist) W Watson (Consumer Representative, Founder of the Hereditary Breast Cancer Group). Recruiting centres (Number of women recruited) Aberdeen: NE Haites, B Gibbons, H Gregory, M McJannett, L McLennan (29); Belfast: PJ Morrison, L Jeffers (12); Birmingham: T Cole, L Burgess, CmcKeown, JEV Morton (24); Bristol Royal Infirmary: Z Rayter (3);Cambridge: J Mackay, J Rankin, LG Bobrow, S Downing, S Everest, A Middleton, B Newcombe (67);Dundee: D Goudie, D Young (24);Edinburgh: M Steel, EDC Anderson, J Campbell, JM Dixon, P Walsh (60); Frenchay HospitalBristol: SJ Cawthorn, M Shere, C Dawe (29); Glasgow: R Davidson, CM Watt (20); Guy’s and St Thomas’ London: SV Hodgson, S Watts (43); Leeds: C Chu, G Turner, E Hazell, L Rae (55); Liverpool: I Ellis, J Birch, C Holcombe, S Holcombe, K Makinson (16);Manchester Regional Genetics Service: DG Evans, G Hall, A Shenton (157);Newcastle: F Douglas, G Seymour (111);Northwick Park: J Paterson, C Cummings, L Jackson (9); Sheffield: OWJ Quarrell, JA Cook, D Kumar (14);Southampton: DM Eccles, G Crawford, S Goodman (34);Sutton and St George’s (or collaborators who referredto this centre): RA Eeles, S Allan, A Ardern-Jones, E Bancroft, C Brewer, R Carpenter, C Chapman, DL Christensen, RC Coombes, S Ebbs, I Fentiman, S Furnell, R Given-Wilson, S Goff, S Gray, M Greenall, G Gui, T Homfray, R Houlston, MW Kissin, I Laidlaw, F Lennard, I Locke, AM Lucassen, F McDuff, K McReynolds, G Mitchell, MWE Morgan, V Murday, U Querci della Rovere, N Rahman, N Sacks, A Salmon, S Shanley, S Shrotria, N Sodha, A Stacey-Clear, C Webster (130).Magnetic resonance image readers (number of cases read)Aberdeen: FJ Gilbert (132), G Needham (75); Barnet: GR Kaplan (19); Belfast: JG Crothers (13); Birmingham: CP Walker (48); Bristol Royal Infirmary: A Jones (10); Cambridge: PD Britton (161), AK Dixon (104), R Sinnatamby (25), RML Warren (759); Dundee: JM Rehman (14), D Sheppard (20); Edinburgh: J Walsh (426); Frenchay Hospital Bristol: ID Lyburn (23), NF Slack (50); Glasgow: LM Wilkinson (24); Guy’s and St Thomas’ London: S Rankin (222); Hillingdon Hospital Middlesex: K Raza (100); Hull: G Hall (81), P Balan (47), LW Turnbull (221); Liverpool: GH Whitehouse (47); Manchester—Christie Hospital/Nightingale Centre: CRM Boggis (80), E Hurley (16), A Jain (4), S Reaney (49), M Wilson (63); Manchester Medical School: JM Hawnaur (183), J Jenkins (4); Newcastle: A Coulthard (234), AJ Potterton (321); Northwick Park: B Shah (57), W Teh (92);Paul Strickland Scanner Centre London: AR Padhani (269); Royal Hospital Haslar Gosport: PJ Buxton (2), JM Domjan (2), PAL Gordon (6); Southampton: M Briley (55), C Rubin (72); Sutton and St George’s: P Kessar (now at Bromley Hospitals NHS Trust; 256); University College Hospital: MA Hall-Craggs (23). XRM Readers (number of films read) Aberdeen: HE Deans (42), K Duncan (47), L Gomersall (30), G Iyengar (3), G Needham (8); Barnet: GR Kaplan (4); Belfast: JG Crothers (12), J McAllister (12), JM Kirby (1);Birmingham: S Bradley (47), MG Wallis (45); Bristol Royal In.rmary: JE Basten (56), E Kutt (52); Cambridge: PD Britton (185), R Davies (5), CDR Flower (9), AH Freeman (240), D O’Driscoll (4), R Sinnatamby (310), RML Warren (426); Dundee: AM Cook (25), CM Walker (25); Edinburgh: A Buttimer (55), A Gilchrist (35), BB Muir (106), J Murray (126), L Smart (10), M Smith (8); Glasgow: C Cordiner (18), J Litherland (16); Guy’s and St Thomas’ London: A Jones (51), S McWilliams (76); Hull: AE Hubbard (146); Liverpool: A Ap-Thomas (1), DA Ritchie (33), F White (32); Manchester—Christie Hospital/Nightingale Centre: DL Asbury (46), U Beetles (14), CRM Boggis (212), R Dobrashian (3), MDJ Harake (15), E Hurley (34), A Jain (20), S Reaney (74), M Wilson (117); Newcastle: B Kaye (55), M McElroy (180), L McLean (145), W Wotherspoon (230);Northwick Park: G Markham (8); Southampton: A Bisset (2), S Hegarty (57), G Michaels (59), N Robson (2); Sutton and St George’s: G Brown (41), J Husband (6), KT Khaw (1), D MacVicar(10), E Moskovic (7), J Murfitt (23). Other radiology/magnetic resonance staff Aberdeen: ML Muirhead, TW Redpath, S Semple; Barnet: M Cunningham, S Turnell; Belfast: Creynolds, R Bridcut, J Winder; Birmingham: P Fergusson, Z Vegnuti; Bristol Royal Infirmary: S Cowley, K Isaacs, P Richardson; Cambridge: J Green, I Joubert, J Pinney, C Pittock, E van Rooyen; Dundee: SJ Gandy, P Martin, T McLeay; Edinburgh: T Lawton, I Marshall, L Thomson; Frenchay Hospital Bristol: H Albarran, V Blake, J Robson; Glasgow: M Cockburn; Guy’s and St Thomas’ London: J Goodey, K McBride; Hull: D Fagge, S Hunter, G Liney; Liverpool: J Chance, J Davies, Z Hussain; Manchester—Christie Hospital/Nightingale Centre: Chammond, W Johnson; Manchester Medical School: JE Adams, Y Watson; Newcastle: L Lewis, M Myers; Northwick Park: D Fox, J Johnson, J Shah; Paul Strickland Scanner Centre, London: L Culver, R Sale, JJ Stirling, NJ Taylor; Royal Hospital Haslar, Gosport: E Boyd, J Evans, W Johnston, S Lindsay, R MacKenzie, H Stansby, B Tailor, L Watts, L WomackSouthampton: A Darekar, S King, N Shepherd; Sutton and St George’s: G Charles-Edwards, E Charles-Edwards, E Scurr (on behalf of all the MRI radiographers Sutton)

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Gareth, E.D., Nisha, K., Yit, L. et al. MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat 145, 663–672 (2014). https://doi.org/10.1007/s10549-014-2931-9

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