Breast Cancer Research and Treatment

, Volume 142, Issue 2, pp 445–453

Is there a role for routine screening MRI in women with LCIS?

  • Tari A. King
  • Shirin Muhsen
  • Sujata Patil
  • Starr Koslow
  • Sabine Oskar
  • Anna Park
  • Mary Morrogh
  • Rita A. Sakr
  • Monica Morrow
Brief Report

Abstract

Women with lobular carcinoma in situ (LCIS) have an elevated breast cancer risk, yet the benefit of MRI screening is unclear. We examined cancer detection rates with mammography alone versus mammography plus MRI in this high-risk population. From a prospectively maintained, single-institution database, we identified 776 patients diagnosed with LCIS after the adoption of screening MRI in April 1999. In addition to annual mammography and breast exam, MRI was used at the discretion of the physician and patient. Kaplan–Meier methods and landmark analyses at 1, 2, and 3 years following LCIS diagnosis were performed to compare rates of cancer detection with or without MRI. MRI screening was performed in 455 (59 %) patients (median, 3/patient). Median time from LCIS diagnosis to first MRI was 9 months (range 0.3–137 months). Patients undergoing MRI were younger (p < 0.0001), premenopausal (p < 0.0001), and more likely to have ≥1 first-degree relative with breast cancer (p = 0.009). At a median follow-up of 58 months, 98/776 (13 %) patients developed cancer. The crude cancer detection rate in both screening groups was 13 %. MRI was not associated with earlier stage, smaller size, or node negativity. Landmark analyses at 1, 2, and 3 years after LCIS diagnosis failed to demonstrate increased cancer detection rates among women having MRI (p = 0.23, 0.26, and 0.13, respectively). Although a diagnosis of LCIS remains a significant risk factor for breast cancer, the routine use of MRI does not result in increased cancer detection rates (short-term), nor does it result in earlier stage at diagnosis, illustrating the importance of defining optimal screening strategies for high-risk patients based on tumor biology rather than numerical risk.

Keywords

LCIS MRI Screening High risk Breast cancer 

Supplementary material

10549_2013_2725_MOESM1_ESM.eps (955 kb)
Supplemental File No. 1 Number of patients entered into the lobular carcinoma in situ (LCIS) surveillance database and use of MRI screening per year, April 1999 to December 2009

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Tari A. King
    • 1
  • Shirin Muhsen
    • 1
  • Sujata Patil
    • 2
  • Starr Koslow
    • 1
  • Sabine Oskar
    • 1
  • Anna Park
    • 1
  • Mary Morrogh
    • 1
  • Rita A. Sakr
    • 1
  • Monica Morrow
    • 1
  1. 1.Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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