Women at Increased Breast Cancer Risk Benefit by Adding Ultrasound, MRI to Yearly Mammography Screening

Adding screening ultrasound or magnetic resonance imaging (MRI) to yearly mammography exams in women with an increased risk of breast cancer and dense breast tissue was shown to result in a higher rate of detection of incident breast cancers.

These findings were published in the April 4, 2012, issue of the Journal of the American Medical Association (JAMA). “Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging may reveal additional breast cancers missed by both mammography and ultrasound screening,” according to the authors of the article.

Wendie A. Berg, MD, PhD, formerly of the American College of Radiology Imaging Network (ACRIN; Philadelphia, PA, USA), and colleagues conducted a study to determine the supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. The study included 2,809 women (with increased cancer risk and dense breasts) at 21 sites who consented to three yearly independent screens with mammography and ultrasound in randomized order. Median age at enrollment was 55 years.
Almost 54% of women had a personal history of breast cancer. After three rounds of both screenings, 612 of 703 women who chose to undergo an MRI had complete data.

A total of 2,662 women underwent 7,473 mammogram and ultrasound screenings, 110 of whom had 111 breast cancer events. Fifty-nine tumors (53%) were detected by mammography, including 33 (30%) that were detected by mammography only; 32 (29%) by ultrasound only; and nine (8%) by MRI only after both mammography and ultrasound screens failed to detect cancer. Eleven tumors (10%) were not detected by any imaging screen. A total of 16 of 612 women (2.6 percent) in the MRI substudy were diagnosed with breast cancer.

Among 4,814 incidence screens in the second and third years combined, 75 women were diagnosed with cancer. The researchers found that supplemental ultrasound increased cancer detection with each annual screen beyond that of mammography, adding detection of 5.3 cancers per 1,000 women in the first year; 3.7 women per 1,000 per year in each of the second and third years; and averaging 4.3 per 1,000 for each of the three rounds of annual screening. The addition of MRI screening additionally increased cancer detection with a supplemental cancer detection yield of 14.7 per 1,000 women. The number of screens needed to detect one tumor was 127 for mammography, 234 for supplemental ultrasound, and 68 for supplemental MRI after negative mammography plus ultrasound screening results.

“Despite its higher sensitivity, the addition of screening MRI rather than ultrasound to mammography in broader populations of women at intermediate risk with dense breasts may not be appropriate, particularly when the current high false-positive rates, cost, and reduced tolerability of MRI are considered,” the authors concluded.

Related Links:
American College of Radiology Imaging Network