Skip to main content

Advertisement

SpringerLink
Log in

Baseline Screening MRI Uptake and Findings in Women with ≥ 20% Lifetime Risk of Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American Cancer Society recommends screening magnetic resonance imaging (MRI) for patients with a ≥ 20% lifetime breast cancer risk. This study assesses the outcomes of baseline MRI screens in women from a high-risk breast clinic (HRBC).

Methods

We retrospectively reviewed patients from our institution’s HRBC, excluding those with prior breast cancer and predisposing genetic mutations. Screening MRI was recommended for a lifetime risk of ≥ 20% using the Tyrer–Cuzick model. We determined baseline MRI results, biopsy rates, and frequency of MRI-detected high-risk lesions (HRLs) and breast cancers.

Results

Overall, 319 women attended our HRBC; median age was 48 years and 4.7% had prior atypia/lobular carcinoma in situ. Screening MRI was recommended for 282 patients, of whom 196 (69.5%) completed a baseline screen. A Breast Imaging-Reporting and Data System (BIRADS) 3 or 4 finding occurred in 19.6% of patients; 23 (12.3%) required 6-month follow-up MRI, 16 (8.6%) underwent core biopsy, and 4 (2.1%) underwent excisional biopsy after initial core. An additional 7 (3.7%) patients had a non-breast incidental finding. An HRL was identified in 2 (1.1%) patients (atypical ductal and lobular hyperplasia, respectively), and 2 (1.1%) were diagnosed with T1N0 breast cancers.

Conclusions

In the setting of an HRBC, 70% of women with a ≥ 20% lifetime risk of breast cancer pursued screening MRI when recommended. On baseline screen, the rate of MRI-detected breast cancer was low (1%); however, malignancies were mammographically occult and identified at an early stage. Despite a low cancer rate, nearly one in four women required additional diagnostic investigation. Prescreening counselling should include a discussion of this possibility, and longer-term follow-up of screening MRI is needed in this high-risk population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Cancer Society Breast Cancer Advisory Group, Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75–89.

    Article  Google Scholar 

  2. 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;351:427–37.

    Article  CAS  Google Scholar 

  3. 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;23:8469–76.

    Article  Google Scholar 

  4. 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 multicenter cohort study (MARIBS). Lancet. 2005;365:1769–78.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  6. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography and clinical breast examination. JAMA. 2004;292:1317–25.

    Article  CAS  Google Scholar 

  7. Warner E, Messersmith H, Causer P, et al. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 2008;148(9):671–9.

    Article  Google Scholar 

  8. Radbruch A, Weberling LD, Kieslich PJ, et al. Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology. 2015;275(3):783–91.

    Article  Google Scholar 

  9. Tedeschi E, Caranci F, Giordano F, et al. Gadolinium retention in the body: what we know and what we can do. Radiol Med. 2017;122(8):589–600.

    Article  Google Scholar 

  10. Shah C, Berry S, Dekhne N, et al. Implementation and outcomes of a multidisciplinary high-risk breast cancer program: The William Beaumont Hospital experience. Clin Breast Cancer. 2012;12(3):215–8.

    Article  Google Scholar 

  11. Hughes RiskApps. Risk clinic—cancer risk assessment system for personalized screening and prevention of breast cancer. https://rsna2015.rsna.org/files/3183/HughesRiskApps%20Product%20Info%20And%20Screenshots7.pdf. Accessed 5 Mar 2020.

  12. Constantino JP, Gail MH, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst. 1999;91(18):1541–8.

    Article  Google Scholar 

  13. Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model incorporating familial and personal risk factors. Stat Med. 2004;23:1111–30.

    Article  Google Scholar 

  14. Saadatmand S, Obdeijn IM, Rutgers EJ, et al. Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer. 2015;137(7):1729–38.

    Article  CAS  Google Scholar 

  15. Yu J, Park A, Morris E, et al. MRI screening in a clinic population with a family history of breast cancer. Ann Surg Oncol. 2008;15(2):452–61.

    Article  Google Scholar 

  16. Sippo DA, Burk KS, Mercaldo SF, et al. Performance of screening breast MRI across women with different elevated breast cancer risk indications. Radiology. 2019;292(1):51–9.

    Article  Google Scholar 

  17. Kriege M, Brekelman CT, Boetes C, et al. Differences between first and subsequent rounds of the MRISC breast cancer screening program for women with a familial or genetic predisposition. Cancer. 2006;106(11):2318–26.

    Article  Google Scholar 

  18. Quante AS, Whittemore AS, Shriver T, et al. Practical problems with clinical guidelines for breast cancer prevention based on remaining lifetime risk. J Natl Cancer Inst. 2015;107(7):djv124.

    Article  Google Scholar 

  19. Yala A, Lehman C, Schuster T, et al. A deep learning mammography-based model for improved breast cancer risk prediction. Radiology. 2019;292:60–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Alison Laws MD, Sarah Dalton DNP, Olga Kantor MD, MS & Suzanne B. Coopey MD

  2. Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Therese M. Mulvey MD, Nicole Jalbert, Katherine A. Harris MD, PhD, Karen J. Krag MD & Elizabeth P. Walsh MD

  3. Department of Interventional Radiology, UMass Memorial Medical Center, Worcester, MA, USA

    Sarah Dalton DNP

Authors
  1. Alison Laws MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Therese M. Mulvey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicole Jalbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Dalton DNP
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olga Kantor MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katherine A. Harris MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karen J. Krag MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elizabeth P. Walsh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Suzanne B. Coopey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suzanne B. Coopey MD.

Ethics declarations

Disclosures

Alison Laws, Therese M. Mulvey, Nicole Jalbert, Sarah Dalton, Olga Kantor, Katherine A. Harris, Karen J. Krag, Elizabeth P. Walsh, and Suzanne B. Coopey have no disclosures to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laws, A., Mulvey, T.M., Jalbert, N. et al. Baseline Screening MRI Uptake and Findings in Women with ≥ 20% Lifetime Risk of Breast Cancer. Ann Surg Oncol 27, 3595–3602 (2020). https://doi.org/10.1245/s10434-020-08853-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08853-4

Search

Navigation