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MRI improved mammography screening sensitivity for older BRCA mutation carriers
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The addition of MRI to mammography significantly improved screening sensitivity among women who harbored BRCA1 or BRCA2 mutations, according to study results.
The sensitivity of the screening combination also was comparable among women aged older than 50 years and those aged younger than 50 years, results showed.
Xuan-Anh Phi, PhD, of University Medical Center Groningen in the Netherlands, and colleagues pooled individual patient data from six screening trials of high-risk individuals.
The trials comprised a combined 1,951 women with BRCA1/2 mutations. The median age of the entire population was 41 years; 16.9% were aged 50 to 59 years and 5.5% were aged 60 years or older.
Of the breast cancers detected, 141 occurred in women aged younger than 50 years, and 43 occurred in women aged 50 years or older.
MRI detected 78.8% of the cancers, and mammography detected 38.6%. The combination of MRI and mammography detected 88.6% of the cancers and was associated with a significant improvement in screening sensitivity compared with mammography alone (93.4% vs. 39.6%; P˂.001). However, the combination of both screening methods was associated with a reduced specificity compared with mammography alone (80.3% vs. 93.6%; P=.0016).
Among women aged younger than 50 years, the addition of MRI to mammography increased sensitivity (93.2% vs. 40%; P˂.001) but decreased specificity (78.7% vs. 93%; P˂.001) compared with mammography alone.
Researchers observed significantly improved sensitivity with the combination screening method compared with mammography alone in women aged 50 years or older (94.1% vs. 38.1%; P˂.001). However, the combination did not improve sensitivity compared with MRI alone (94.1% vs. 84.4%; P=.28).
Researchers also noted the sensitivity of MRI plus mammography was comparable between women aged at least 50 years and those aged younger than 50 years (94.1% vs. 93.2%; P=.79).
“Given the evidence from this meta-analysis, it would be reasonable to offer breast MRI screening to women with BRCA1/2 mutations beyond aged 50 years and also to reassess any existing recommendations that MRI screening for BRCA1/2 mutation carriers be discontinued at age 50 years,” Phi and colleagues wrote.
Disclosure: The researchers report honoraria, travel accommodations and research funding from, consultant roles with and advisory roles with Bayer Healthcare, Bracco Diagnostics, Genomic Health Canada, IMS-Giotto, Medicor, Merck, Novomed, Philips Healthcare and Siemens.
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