Breast MRI in Women with Personal History of Breast Cancer
BCSC investigators and patient partners evaluate the performance of Breast MRI in women with a history of breast cancer
In the Radiology article published June 4, 2019, entitled “Surveillance Breast MRI and Mammography: Comparison in Women with a Personal History of Breast Cancer,” Dr. Wernli and BCSC investigators including two patient partners (Ms. Bush and Ms. Johnson) evaluated the performance of surveillance breast MRI compared with mammography in women with prior breast cancer. Surveillance imaging, or screening in women with prior breast cancer, aims to identify second breast cancer events early, either a recurrence or a new primary breast cancer. The main findings indicate that surveillance breast MRI in community practice resulted in higher biopsy rates (odds ratio [OR], 2.2) and cancer detection rates (OR, 1.7) for second breast cancer events compared with mammography alone. However, breast MRI was no different than mammography alone in sensitivity (OR, 1.1) for breast cancer detection and in interval cancer rates (OR, 1.1), indicating that mammography did not miss more cancers that would become clinically detectable during the 1-year screening interval. Further, comparisons of new imaging strategies for surveillance of women with a personal history of breast cancer need to account for differences in women, incident tumor, and treatment characteristics. Our study identified that women who received breast MRI differed from women who only received a mammogram. Hence, the evaluation of performance of breast MRI among single institutions do not fully account for these differences. The authors state, “…understanding the effect of the latest imaging tests for surveillance of second breast cancer events requires an understanding of the baseline cancer rate in the evaluated population and characteristics in women to obtain accurate performance estimates.” Further, “patient preferences balanced by population health needs may guide the consideration of multimodality surveillance strategies.” Current funding to the BCSC will continue to explore personalizing breast imaging based on risk of second breast cancer events.
Full Text Citation and Link: Wernli KJ, Ichikawa L, Kerlikowske K, Buist DSM, Brandzel SD, Bush M, Johnson D, Henderson LM, Nekhlyudov L, Onega T, Sprague BL, Lee JM, Lehman CD, Miglioretti DL. Surveillance Breast MRI and Mammography: Comparison in Women with a Personal History of Breast Cancer. Radiology. 2019 Jun 4:182475. doi: 10.1148/radiol.2019182475. PMID: 31161975 [Link to Article]
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Posted by: Karen Wernli, PhD