Screening MRI provides value for women with personal history of breast cancer, high-risk lesions

Breast MRI screening should be “strongly considered” for women with a personal history of breast cancer or high-risk lesions, according to new research published in Radiology.

The American College of Radiology now recommends screening MRI for women with a personal history of breast cancer and dense breasts or a prior cancer diagnosis before the age of 50. As other groups consider making their own recommendations for breast MRI screening, the study’s authors wanted to provide additional clarity on this topic by working to correct a limitation of currently available research.

“To our knowledge, no single cohort study robustly compared performance across groups, and thus prior studies do not allow for direct comparison of examination performance between women with a personal history of breast cancer and those with a history of high-risk lesion,” wrote Dorothy A. Sippo, MD, department of radiology at Massachusetts General Hospital in Boston, and colleagues. “Given this background, the purpose of our study was to evaluate screening breast MRI performance across women with different elevated breast cancer risk indications, including women with a personal history of breast cancer or high-risk lesion.”

Sippo et al. explored data from more than 5,000 screening breast MRI examinations from more than 2,500 women performed at a single institution from 2011 to 2014. The mean patient age was 52 years old, with ages ranging from 23 to 86 years old. Sixty-seven cancers were detected.

The data was separated into groups based on each patient’s reason for being screened, including carrying the BRCA mutation or a history of chest radiation (BRCA/RT group), a family history of breast cancer (FH group), a personal history of breast cancer (PH group) and a prior high-risk lesion (HRL group).

Breast MRI screening is already “clearly recommended” for patients in the BRCA/RT group, the authors explained, so they analyzed how that group’s screening statistics compared with the others.

Overall, the cancer detection rate (CDR) was 26 per 1,000 examinations for the BRCA/RT group, 8 per 1,000 examinations for the FH group, 12 per 1,000 examinations for the PH group and 15 per 1,000 examinations for the HRL group. Sensitivity and specificity were both highest for the PH group (88% and 95%, respectively).

After applying a “multivariable logistic regression model,” however, Sippo and colleagues found “no difference in the CDR between the PH and HRL groups compared with the BRCA/RT group, but there was a lower CDR in the FH group.”

“Most cancers (52%, 35 of 67) were detected in patients with a personal history of breast cancer, who comprised more than half (55%, 2835 of 5170) of all examinations,” the authors wrote. “Screening breast MRI should be strongly considered for patients with a personal history of breast cancer, as screening more patients at elevated risk will result in more cancers detected overall. Worse test performance was found in women with only family history of breast cancer, with lower CDR and positive predictive values compared with those with BRCA mutation or previous chest radiation.”