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Breast MRI may find missed cancer. (Specificity, Cost at Issue).
CHICAGO -- Magnetic resonance imaging detected breast tissue abnormalities that weren't seen on mammography in three recent studies, but the investigators are at odds on whether the technology should be used as a routine screening tool in women at high risk for breast cancer.
At issue are conflicting results regarding the modality's specificity and concerns about the emotional and economic toll of a large number of false-positive results.
In the largest of the three studies presented at the annual meeting of the American Society of Clinical Oncology; 40 breast cancers in 1,905 high-risk women were found over 2 years. The sensitivity rates were 71% for contrast-enhanced MRI, 36% for mammography, and 16% for clinical breast exam, said Dr. Jan G.M. Klijn of the Rotterdam (the Netherlands) Family Cancer Clinic where the study took place.
All participants were at high risk for breast cancer because of a mutation in the BRCA1 or BRCA2 gene and/or a familial risk of more than 15% for the disease. Women received two clinical breast examinations per year and annual mammography and contrast-enhanced MRI exams.
The sensitivity differences among the screening methods were even more pronounced for the 23% of cancers that had invaded the lymph nodes. In those cases, the sensitivity of MRI was 83%, compared with 26% for mammography and 20% for clinical breast examination. The high sensitivity of MRI is particularly significant considering nearly half of the tumors were smaller than 1 cm, Dr. Klijn noted.
MRI wasn't as good at distinguishing carcinoma from benign breast disease, with a specificity of 88%, compared with 95% for mammography and 97% for clinical breast examination. The trade-off for the reduced specificity "is a greater number of breast cancers found in early, more curable stages and, as a result, a reduction in the number of deaths" among women at high risk for the disease, he said.
He recommended that MRI be used in addition to mammography in women at high risk for the disease.
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