Guidelines recommend consideration of screening MRI for patients with high-risk breast lesions (HRLs), acknowledging limited data for this moderate-risk population.
This study identified patients with atypical ductal/lobular hyperplasia (ADH/ALH), lobular carcinoma in situ, (LCIS) or both evaluated at our high-risk clinic. Patients were categorized as having received screening mammography (MMG) alone vs. MMG and breast MRI (MMG+MRI). Inverse probability weighting based on propensity scores (PS) representing likelihood of MRI use was applied to Kaplan-Meier and Cox regression analyses to determine cancer detection and biopsy rates by screening group.
Among 908 eligible patients, 699 (77%) patients with available follow-up data were analyzed (542 with ADH/ALH and 157 with LCIS). Of the 699 patients, 540 (77%) received MMG alone, and 159 (23%) received MMG + MRI. The median follow-up period was 25 months, during which a median of two MRIs were performed. After PS-weighting, the characteristics of each screening group were well-balanced with respect to age, race, body mass index (BMI), menopausal status, breast density, family history, HRL type, and chemoprevention use. The 4 year breast cancer detection rate was 3.6% with both MMG alone and MMG+MRI (p = 0.89). The breast biopsy rates were significantly higher with MMG+MRI (30.5% vs12.6%; hazard ratio [HR], 2.67; p < 0.001). All breast cancers were clinically node-negative and pathologic stage 0 or 1. Among five cancers in the MMG+MRI group, two were MRI-detected, two were MMG-detected, and one was detected on clinical exam.
Screening MRI did not improve cancer detection, and cancer characteristics were favorable whether screened with MMG alone or MMG + MRI. These findings question the benefit of MRI for patients with HRL, although longer-term follow-up study is needed.
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This study was supported by a Komen Scholars Award, Rebecca Winn Matchett, Christopher Matchett, and the Winn Family Foundation.
Tari A. King reports speaker’s honoraria and advisory board participation for Exact Sciences (formerly Genomic Health) and serves on the Global Advisory Board, Besins Healthcare. Judy E. Garber reports institutional research funding from Myriad Genetics, Ambry Genetics and Invitae Genetics; consulting for Helix Genetics (compensation) and Earli (no compensation); leading two clinical trials for AstraZeneca; serving on the scientific advisory board of Konica Minolta (no compensation); conducting a sponsored lecture for Clinical Care Options, LLC; Editorial Services publications, President, Fellows of the AACR Academy, and member, Foundation Board of the American Association for Cancer Research; co-scientific director, Breast Cancer Research Foundation; board of directors, Facing Our Risk of Cancer Empowered; spousal consulting fees from Novartis Oncology, GTx Pharmaceuticals, Aleta BioTherapeutics and H3 Biomedicine, Inc.; a spousal advisory board membership at Oric Pharmaceuticals; and spousal scientific advisory board memberships at Kronos Bio, Susan G. Komen for the Cure, James P. Wilmot Foundation, Inc., Diane Helis Henry Medical Research Foundation, Adrienne Helis Melvin Medical Research Foundation, and Global Biological Standards Institute.
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Presented in poster format at the San Antonio Breast Cancer Symposium, San Antonio, TX, 7–10 December, 2021.
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Laws, A., Katlin, F., Hans, M. et al. Screening MRI Does Not Increase Cancer Detection or Result in an Earlier Stage at Diagnosis for Patients with High-Risk Breast Lesions: A Propensity Score Analysis. Ann Surg Oncol 30, 68–77 (2023). https://doi.org/10.1245/s10434-022-12568-z