Breast cancer: MRI-based screening tops mammography in women with familial risk

  • Lancet Oncol

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Annual MRI plus biennial mammography detects more breast cancer and at an earlier stage than annual mammography in women with familial risk but no mutations in BRCA1, BRCA2, and TP53 genes.
  • The advantages of better detection are somewhat offset by higher false positives.

Why this matters

  • Fewer late-stage cancers may reduce reliance on chemotherapy and mortality.

Study design

  • Multicenter randomized controlled trial (RCT) at 12 hospitals in the Netherlands comparing annual MRI+biennial mammography (n=675) vs annual mammography (n=680) in women aged 30-55 years with familial predisposition.
  • Primary outcomes were number, size, and nodal status of detected breast cancers.
  • All patients underwent annual clinical breast examination.
  • Funding: Dutch Government ZonMw; others.

Key results

  • Annual MRI+biennial mammography vs annual mammography yielded:
    • More detectable cancers (40 vs 15; P=.0017).
    • Smaller median size of invasive cancers (9 vs 17 mm; P=.010).
    • Lower frequency of node-positive tumors (17% vs 63%; P=.023).
    • Greater likelihood of stages T1a+T1b (48% vs 7%; P=.035).
    • Less likelihood of T2 or higher stages (4% vs 13%; P=.035).
    • Higher likelihood of false positives (4% vs 0%; P<.001>

Limitations

  • Small number of detected cancers.

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