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Primary Studies on Breast MRI Screening of High-Risk Women

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Breast MRI for High-risk Screening

Abstract

In this chapter, we first provide an overview of the general context given by screening mammography in the general female population, including the hot debate about its harm-to-benefit balance and the wide range of estimated overdiagnosis, associated with overtreatment. In particular, the limitations of the principle one size fits all underlying population-based screening programs is discussed, with the perspectives for more personalized approaches, based on risk stratification. We then describe the main results obtained by intra-individual prospective studies comparing breast magnetic resonance (MRI) with clinical breast examination and conventional imaging, i.e., mammography and ultrasound (US), for screening women at high risk of breast (BRCA mutation carriers and women with strong family history of breast/ovarian cancers). In particular, we distinguish the initial studies, published from 2000 to 2005, on whose results the American Cancer Society based its 2007 guidelines in favor of MRI as an adjunct to mammography for high-risk screening, from the subsequent studies published between 2007 and 2015. The latter expanded the existing body of knowledge showing not only that MRI is more accurate than mammography and/or US for high-risk screening but also that, when MRI is performed, the added value of conventional imaging is low, leading to the reverted principle of mammography as an adjunct to MRI, only if necessary. In addition, the ten key points suggested in 2010 by the multidisciplinary panel of EUSOMA for MRI screening of high-risk women are here reported. Finally, some relevant retrospective studies specifically focusing on the contribution of mammography and on MRI false-negative cases in high-risk screening are considered.

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Notes

  1. 1.

    See also Chap. 11 (in particular Table 11.1) on this matter.

  2. 2.

    Unless differently specified, in this chapter, with LTR we mean cumulative LTR.

  3. 3.

    Data on clinical breast examination will be illustrated below, with the final results of the HIBCRIT-1 study.

  4. 4.

    See also Chap. 3 on this matter.

Abbreviations

ACS:

American Cancer Society

AUC:

Area under the curve

BC:

Breast cancer

CBE:

Clinical breast examination

CE-MRI:

Contrast-enhanced magnetic resonance imaging

DBT:

Digital breast tomosynthesis

DCIS:

Ductal carcinoma in situ

EBM:

Evidence-based medicine

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

LTR:

Lifetime risk

MRI:

Magnetic resonance imaging

PPV:

Positive predictive value

RCT:

Randomized controlled trial

ROC:

Receiver operating characteristic

US:

Ultrasound

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Authors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  2. Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Francesco Sardanelli

  3. Department of Cell Biology and Neurosciences, Molecular and Cellular Imaging Unit, Istituto Superiore di Sanità (ISS), Rome, Italy

    Franca Podo

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  1. Francesco Sardanelli
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  2. Franca Podo
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Correspondence to Francesco Sardanelli .

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Editors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  2. Department of Cell Biology and Neurosciences Molecular and Cellular Imaging Unit, Istituto Superiore di Sanità (ISS), Rome, Italy

    Franca Podo

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Sardanelli, F., Podo, F. (2020). Primary Studies on Breast MRI Screening of High-Risk Women. In: Sardanelli, F., Podo, F. (eds) Breast MRI for High-risk Screening. Springer, Cham. https://doi.org/10.1007/978-3-030-41207-4_9

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  • DOI: https://doi.org/10.1007/978-3-030-41207-4_9

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