NEW YORK (Reuters Health) - New research indicates that MRI is more sensitive than mammography, ultrasound, or clinical breast examination (CBE) for detecting breast cancer in women with BRCA1 or BRCA2 mutations.
This finding, which appears in the Journal of the American Medical Association for September 15th, is similar to the conclusion reached by a study recently reported in The New England Journal of Medicine (see Reuters Health report July 28, 2004). However, unlike the earlier study, the present study included a comparison with ultrasound.
Despite the improved sensitivity seen with MRI surveillance, lead author Dr. Ellen Warner, from Toronto-Sunnybrook Regional Cancer Centre, and colleagues note that further studies are needed to determine if a surveillance strategy involving MRI actually reduces mortality.
In the current study, 236 women with BRCA1/2 mutations underwent one to three annual screening examinations that included MRI, mammography, and ultrasound. CBE was performed at each imaging visit as well as at 6-month intervals.
The radiologic images were read independently by a radiologist who rated the likelihood of malignancy on a 5-point scale. Lesions with a score of 4 or 5 were considered suspicious for malignancy and were referred for biopsy.
Overall, 22 cancers were detected, including 16 invasive and 6 in situ lesions. MRI detected 17 (77%) of these malignancies, whereas mammography, ultrasound, and CBE only detected 8 (36%), 7 (33%), and 2 (9.1%), respectively. The corresponding specificity values were 95.4%, 99.8%, 96%, and 99.3%. One interval cancer occurred.
Combining all four modalities into one screening approach resulted in a sensitivity of 95%, whereas the sensitivity of mammography plus SBE, the currently used approach, was just 45%.
“Our results support the position that MRI-based screening is likely to become the cornerstone of breast cancer surveillance for BRCA1 and BRCA2 mutation carriers,” the researchers conclude.
Source: JAMA 2004;292:1317-1325. [ Google search on this article ]
MeSH Headings:Breast Neoplasms: Neoplasms: Neoplasms by Site: Genes, BRCA1: DiseasesCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
