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Additional screening improves detection of new breast cancers following surgery
The addition of MRI or ultrasonography to annual mammography screening improved the detection of early-stage breast cancers in women who had breast conservation surgery and radiotherapy when aged 50 years or younger, according to research data published in JAMA Oncology.
“Our study results can be used not only to inform patient and clinician decision-making regarding the best methods of screening after breast conservation therapy and radiotherapy, but also to develop more personalized screening guidelines and recommendations for women at increased risk for breast cancer,” Woo Kyung Moon, MD, professor of radiology and chief of breast imaging at Seoul National University College of Medicine, and colleagues wrote.
Previous studies indicate that, at 5-year follow-up, approximately 10% of women treated with breast conservation therapy and radiotherapy develop either a local recurrence or a new primary cancer in the conserved or contralateral breast. Recurrence increases to 20% at 10-year follow-up.
American Cancer Society guidelines state there is insufficient evidence to recommend for or against MRI screenings for women with a personal history of breast cancer, unless they have a genetic mutation and more than a 20% to 25% lifetime risk for breast cancer.
Still, MRI or ultrasonography screenings are increasingly used to detect second breast cancers in women following breast conserving surgery and radiotherapy, despite limited evidence.
To compare outcomes of mammography alone or combined with MRI or ultrasonography screening, researchers conducted a multicenter, prospective, nonrandomized study of 754 women (median age, 43 years) who underwent breast conservation therapy and radiotherapy after breast cancer diagnosis at age 50 years or younger. Researchers evaluated 2,065 mammograms, ultrasonography and MRI screenings from Dec. 1, 2010, until Jan. 31, 2016 at six academic institutions.
Cancer detections rate, sensitivity and specificity served as primary outcomes.
The screenings detected 17 cancers (2.3%), of which 13 (76.5%) were stage 0 or stage 1.
Cancer detection occurred more frequently in women with mammography and MRI than with mammography alone (8.2 vs. 4.4 per 1,000; P = .003). Sensitivity also appeared higher with the addition of MRI to mammography (100% vs. 53%; P = .01).
Ultrasonography with mammography conferred higher rates of cancer detection than mammography alone (6.8 vs. 4.4 per 1,000; P = .03).
The specificity of mammography with MRI or ultrasonography appeared lower than mammography alone (87% vs. 88% vs. 96%; P < .001).
Among the study’s limitations, researchers noted that 17 women had BRCA mutations — two of whom developed second cancers — which could have affected the cancer detection rate. Further, only 61 of 754 participants (8.1%) underwent genetic testing before making a treatment decision. – by Chuck Gormley
Disclosure: Bayer Korea funded this study. The researchers report no relevant financial disclosures.
Perspective
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This paper evaluates the efficacy of breast MRI and ultrasound as supplements to mammography in women with a history of breast carcinoma diagnosed prior to age 50 years. This is in keeping with previous data in women with dense breasts. The findings in this group are similar to other studies with the combination of MRI and mammography being more efficacious than the combination of ultrasound and mammography, although ultrasound identified some additional cancers.
The use of MRI has been limited, in part, due to the high cost of this examination, as well as a paucity of studies like this one that demonstrate benefits in a defined population. “Fast” MRI shows considerable promise for providing a less expensive, accurate alternative to conventional breast MRI.
Breast MRI has almost certainly been underutilized as a screening tool in women with a personal history of breast carcinoma. With more data, hopefully this will change.