Breast Cancer?

Sensitivity was increased, but so were false-positive rates.

The value of adding ultrasonography or magnetic resonance imaging (MRI) to screening

mammography remains unknown. Investigators recruited asymptomatic women (median age
at enrollment, 55) with dense breasts and at least one additional breast cancer risk factor (e.g.,
BRCA mutations, histories of breast cancer) to undergo three annual rounds of screening
mammography and ultrasound. Tests were considered positive when recommendations were
other than routine screening and Breast Imaging-Reporting and Data System (BI-RADS)

scores were 3. Women were eligible for the MRI substudy if they completed all three
rounds of screening and agreed to undergo subsequent contrast-enhanced MRI. A reference
standard was defined as the most severe biopsy results (whether cancerous or not) within 1
year of mammographic screening. A total of 2321 women completed the third screen and had
reference standards; 612 of these women were included in the MRI analysis.

Overall, 111 primary breast cancers (80% invasive) were diagnosed. Of these, 30% were
detected only by mammography, 29% were detected only by ultrasound, 8% were detected
only by MRI, and 10% were not detected with any form of imaging. Supplemental ultrasound
increased cancer detection by an average of 4.3 cases per 1000 women with each round.
Adding MRI further increased cancer detection by an average of 14.7 cases per 1000 women.
The number of screens needed to detect one cancer was 127 for mammography, 234 for
supplemental ultrasound, and 68 for MRI when mammography and ultrasound screens were
both negative. Specificity was reduced with the addition of either ultrasound or MRI.

Comment: Supplemental breast magnetic resonance imaging enhances sensitivity of cancer

detection in women at excess risk for the disease — but, in addition to raising false-positive
rates, this modality is more costly and uncomfortable than mammography or ultrasound.
Although use of ultrasound rather than MRI as a supplement to mammographic screening in
intermediate-risk women with dense breasts might seem appealing, the authors point out that
low reimbursement rates and the shortage of qualified breast sonographers could make this
strategy difficult to implement