Journal Article
. 2016 Apr;280(3).
doi: 10.1148/radiol.2016151419.

Breast Cancers Detected at Screening MR Imaging and Mammography in Patients at High Risk: Method of Detection Reflects Tumor Histopathologic Results

Janice S Sung 1 Sarah Stamler 1 Jennifer Brooks 1 Jennifer Kaplan 1 Tammy Huang 1 D David Dershaw 1 Carol H Lee 1 Elizabeth A Morris 1 Christopher E Comstock 1 
  • PMID: 27097237
  •     33 References
  •     24 citations


Purpose To compare the clinical, imaging, and histopathologic features of breast cancers detected at screening magnetic resonance (MR) imaging, screening mammography, and those detected between screening examinations (interval cancers) in women at high risk. Materials and Methods This retrospective institutional review board-approved, HIPAA-compliant review of 7519 women at high risk for breast cancer who underwent screening with MR imaging and mammography between January 2005 and December 2010 was performed to determine the number of screening-detected and interval cancers diagnosed. The need for informed consent was waived. Medical records were reviewed for age, risk factors (family or personal history of breast cancer, BRCA mutation status, history of high-risk lesion or mantle radiation), tumor histopathologic results, and time between diagnosis of interval cancer and most recent screening examination. The χ(2) test and logistic regression methods were used to compare the features of screening MR imaging, screening mammography, and interval cancers. The Wilcoxon signed-rank test was used to calculate P values. Results A total of 18 064 screening MR imaging examinations and 26 866 screening mammographic examinations were performed. Two hundred twenty-two cancers were diagnosed in 219 women, 167 (75%) at MR imaging, 43 (19%) at mammography, and 12 (5%) interval cancers. Median age at diagnosis was 52 years. No risk factors were associated with screening MR imaging, screening mammography, or interval cancer (P > .06). Cancers found at screening MR imaging were more likely to be invasive cancer (118 of 167 [71%]; P < .0001). Of the 43 cancers found at screening mammography, 38 (88%) manifested as calcifications and 28 (65%) were ductal carcinoma in situ. Interval cancers were associated with nodal involvement (P = .005) and the triple-negative subtype (P = .03). Conclusion In women at high risk for breast cancer who underwent screening with mammography and MR imaging, invasive cancers were more likely to be detected at MR imaging, whereas most cancers detected at screening mammography were ductal carcinoma in situ. Interval cancers were found infrequently and were more likely to be node positive and of the triple-negative subtype. (©) RSNA, 2016.

A BRCA1/2 mutation, high breast density and prominent pushing margins of a tumor independently contribute to a frequent false-negative mammography.
Madeleine Tilanus-Linthorst, Leon Verhoog, +7 authors, Cecile Brekelmans.
Int J Cancer, 2002 Sep 28; 102(1). PMID: 12353239
Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer.
Ellen Warner, Hans Messersmith, +3 authors, Donald Plewes.
Ann Intern Med, 2008 May 07; 148(9). PMID: 18458280
Highly Cited. Systematic Review.
Local recurrence after conservative surgery and radiation therapy for ductal carcinoma in situ: Possible importance of family history.
H Hiramatsu, B A Bornstein, +8 authors, J R Harris.
Cancer J Sci Am, 1995 May 01; 1(1). PMID: 9166455
Biologic characteristics of interval and screen-detected breast cancers.
F D Gilliland, N Joste, +4 authors, C R Key.
J Natl Cancer Inst, 2000 May 04; 92(9). PMID: 10793111
Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.
Linda L Humphrey, Mark Helfand, Benjamin K S Chan, Steven H Woolf.
Ann Intern Med, 2002 Sep 03; 137(5 Part 1). PMID: 12204020
Highly Cited.
Long-term impact of young age at diagnosis on treatment outcome and patterns of failure in patients with ductal carcinoma in situ treated with breast-conserving therapy.
Frank A Vicini, Simona Shaitelman, +6 authors, Alvaro A Martinez.
Breast J, 2013 Jul 03; 19(4). PMID: 23815268
Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis.
I Kong, S A Narod, +12 authors, E Rakovitch.
Curr Oncol, 2014 Feb 14; 21(1). PMID: 24523627    Free PMC article.
Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition.
Mieke Kriege, Cecile T M Brekelmans, +16 authors, Magnetic Resonance Imaging Screening Study Group.
N Engl J Med, 2004 Jul 30; 351(5). PMID: 15282350
Highly Cited.
Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers.
Lauren Scheuer, Noah Kauff, +9 authors, Kenneth Offit.
J Clin Oncol, 2002 Mar 01; 20(5). PMID: 11870168
Screening women at high risk for breast cancer with mammography and magnetic resonance imaging.
Constance D Lehman, Jeffrey D Blume, +14 authors, International Breast MRI Consortium Working Group.
Cancer, 2005 Apr 01; 103(9). PMID: 15800894
Multimodality screening of high-risk women: a prospective cohort study.
Susan P Weinstein, A Russell Localio, +3 authors, Mitchell D Schnall.
J Clin Oncol, 2009 Nov 04; 27(36). PMID: 19884532    Free PMC article.
Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination.
Ellen Warner, Donald B Plewes, +10 authors, Steven A Narod.
JAMA, 2004 Sep 16; 292(11). PMID: 15367553
Highly Cited.
Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer.
Christiane K Kuhl, Simone Schrading, +5 authors, Hans H Schild.
J Clin Oncol, 2005 Nov 19; 23(33). PMID: 16293877
Highly Cited.
Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS).
M O Leach, C R M Boggis, +15 authors, MARIBS study group.
Lancet, 2005 May 25; 365(9473). PMID: 15910949
Highly Cited.
NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis.
Therese B Bevers, Benjamin O Anderson, +23 authors, National Comprehensive Cancer Network.
J Natl Compr Canc Netw, 2009 Nov 26; 7(10). PMID: 19930975
Highly Cited. Review.
Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma.
Andrea K Ng, Judy E Garber, +7 authors, Peter M Mauch.
J Clin Oncol, 2013 Apr 24; 31(18). PMID: 23610104
Ductal carcinoma in situ: treatment or active surveillance?
Henry M Kuerer.
Expert Rev Anticancer Ther, 2015 May 06; 15(7). PMID: 25938920
Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.
László Tabár, Bedrich Vitak, +10 authors, Stephen W Duffy.
Radiology, 2011 Jun 30; 260(3). PMID: 21712474
Highly Cited.
Complementary approaches to assessing risk factors for interval breast cancer.
Jan T Lowery, Tim Byers, +5 authors, Judy Mouchawar.
Cancer Causes Control, 2010 Oct 28; 22(1). PMID: 20978835
Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis.
Kathryn P Lowry, Janie M Lee, +8 authors, G Scott Gazelle.
Cancer, 2011 Sep 22; 118(8). PMID: 21935911    Free PMC article.
Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results.
Francesco Sardanelli, Franca Podo, +26 authors, Alessandro Del Maschio.
Radiology, 2007 Jan 25; 242(3). PMID: 17244718
Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers.
P L Porter, A Y El-Bastawissi, +7 authors, E White.
J Natl Cancer Inst, 1999 Dec 02; 91(23). PMID: 10580027
Breast magnetic resonance image screening and ductal lavage in women at high genetic risk for breast carcinoma.
Anne-Renee Hartman, Bruce L Daniel, +8 authors, Sylvia K Plevritis.
Cancer, 2004 Jan 28; 100(3). PMID: 14745863
Detection of ductal carcinoma in situ in women undergoing screening mammography.
Virginia L Ernster, Rachel Ballard-Barbash, +10 authors, Berta M Geller.
J Natl Cancer Inst, 2002 Oct 17; 94(20). PMID: 12381707
Highly Cited.
The development of interval breast malignancies in patients with BRCA mutations.
Ian K Komenaka, Beth-Ann Ditkoff, +6 authors, Freya R Schnabel.
Cancer, 2004 May 13; 100(10). PMID: 15139048
American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version).
M Elizabeth H Hammond, Daniel F Hayes, +31 authors, College of American Pathologists.
Arch Pathol Lab Med, 2010 Jul 01; 134(7). PMID: 20586616
Highly Cited. Systematic Review.
Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study.
Constance D Lehman, Claudine Isaacs, +11 authors, Constantine Gatsonis.
Radiology, 2007 Jul 21; 244(2). PMID: 17641362
Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk.
C T Brekelmans, C Seynaeve, +10 authors, Rotterdam Committee for Medical and Genetic Counseling.
J Clin Oncol, 2001 Feb 22; 19(4). PMID: 11181654
MRI breast screening in high-risk women: cancer detection and survival analysis.
D Gareth Evans, Evans D Gareth, +19 authors, Duffy Stephen.
Breast Cancer Res Treat, 2014 Apr 02; 145(3). PMID: 24687378
American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography.
Debbie Saslow, Carla Boetes, +13 authors, American Cancer Society Breast Cancer Advisory Group.
CA Cancer J Clin, 2007 Mar 30; 57(2). PMID: 17392385
Highly Cited.
Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update.
Antonio C Wolff, M Elizabeth H Hammond, +19 authors, College of American Pathologists.
J Clin Oncol, 2013 Oct 09; 31(31). PMID: 24101045
Highly Cited.
The randomized trials of breast cancer screening: what have we learned?
Robert A Smith, Stephen W Duffy, +3 authors, Tony H H Chen.
Radiol Clin North Am, 2004 Sep 01; 42(5). PMID: 15337416
Overdiagnosis and overtreatment of breast cancer.
Michael Alvarado, Elissa Ozanne, Laura Esserman.
Am Soc Clin Oncol Educ Book, 2012 Jan 01;. PMID: 24451829
Breast Cancer Screening for High-Risk Patients of Different Ages and Risk - Which Modality Is Most Effective?
Elizabeth Wellings, Lauren Vassiliades, Reem Abdalla.
Cureus, 2017 Jan 31; 8(12). PMID: 28133583    Free PMC article.
MRI appearance of invasive subcentimetre breast carcinoma: benign characteristics are common.
Matthias Meissnitzer, D David Dershaw, +3 authors, Elizabeth A Morris.
Br J Radiol, 2017 Apr 30; 90(1074). PMID: 28452624    Free PMC article.
Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness.
Laura Heacock, Alana A Lewin, +6 authors, Linda Moy.
J Magn Reson Imaging, 2017 Nov 28; 47(6). PMID: 29178258    Free PMC article.
Not all false positive diagnoses are equal: On the prognostic implications of false-positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening.
Christiane K Kuhl, Annika Keulers, +3 authors, Simone Schrading.
Breast Cancer Res, 2018 Feb 11; 20(1). PMID: 29426360    Free PMC article.
Errors in Mammography Cannot be Solved Through Technology Alone
Ernest Usang Ekpo, Maram Alakhras, Patrick Brennan.
Asian Pac J Cancer Prev, 2018 Feb 27; 19(2). PMID: 29479948    Free PMC article.
The added value of mammography in different age-groups of women with and without BRCA mutation screened with breast MRI.
Suzan Vreemann, Jan C M van Zelst, +5 authors, Ritse M Mann.
Breast Cancer Res, 2018 Aug 05; 20(1). PMID: 30075794    Free PMC article.
Trends in breast cancer mortality by stage at diagnosis among young women in the United States.
Fangjian Guo, Yong-Fang Kuo, +2 authors, Abbey B Berenson.
Cancer, 2018 Sep 07; 124(17). PMID: 30189117    Free PMC article.
Addition of triple negativity of breast cancer as an indicator for germline mutations in predisposing genes increases sensitivity of clinical selection criteria.
Juliane Hoyer, Georgia Vasileiou, +8 authors, André Reis.
BMC Cancer, 2018 Sep 28; 18(1). PMID: 30257646    Free PMC article.
Contrast-enhanced MRI for breast cancer screening.
Ritse M Mann, Christiane K Kuhl, Linda Moy.
J Magn Reson Imaging, 2019 Jan 20; 50(2). PMID: 30659696    Free PMC article.
Added value of histogram analysis of apparent diffusion coefficient maps for differentiating triple-negative breast cancer from other subtypes of breast cancer on standard MRI.
Hong-Li Liu, Min Zong, +5 authors, Yan-Ni Jiang.
Cancer Manag Res, 2019 Oct 01; 11. PMID: 31564982    Free PMC article.
Blending Insights from Implementation Science and the Social Sciences to Mitigate Inequities in Screening for Hereditary Cancer Syndromes.
Laura Senier, Colleen M McBride, +2 authors, David A Chambers.
Int J Environ Res Public Health, 2019 Oct 18; 16(20). PMID: 31618814    Free PMC article.
Can mammogram readers swiftly and effectively learn to interpret first post-contrast acquisition subtracted (FAST) MRI, a type of abbreviated breast MRI?: a single centre data-interpretation study.
Lyn I Jones, Rebecca Geach, +5 authors, Janet A Dunn.
Br J Radiol, 2019 Sep 29; 92(1104). PMID: 31559859    Free PMC article.
Feasibility of abbreviated magnetic resonance imaging (AB-MRI) screening in women with a personal history (PH) of breast cancer.
Yeong Yi An, Sung Hun Kim, +2 authors, Ye Won Jeon.
PLoS One, 2020 Mar 13; 15(3). PMID: 32163500    Free PMC article.
Abbreviated MRI of the Breast: Does It Provide Value?
Doris Leithner, Linda Moy, +3 authors, Katja Pinker.
J Magn Reson Imaging, 2018 Sep 09; 49(7). PMID: 30194749    Free PMC article.
Differences between screen-detected and interval breast cancers among BRCA mutation carriers.
Melissa Pilewskie, Emily C Zabor, +5 authors, Maxine S Jochelson.
Breast Cancer Res Treat, 2019 Jan 24; 175(1). PMID: 30673971    Free PMC article.
Differential diagnosis of plasma cell mastitis and invasive ductal carcinoma using multiparametric MRI.
Rong Chen, Baoquan Hu, +4 authors, Yan Xu.
Gland Surg, 2020 May 19; 9(2). PMID: 32420252    Free PMC article.
Evaluation of breast screening strategies in a high risk breast and ovarian cancer clinic.
Anne T Knisely, Martha E Stewart, +3 authors, Kari L Ring.
Gynecol Oncol Rep, 2020 Jun 04; 33. PMID: 32490124    Free PMC article.
Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening.
Christopher E Comstock, Constantine Gatsonis, +14 authors, Christiane K Kuhl.
JAMA, 2020 Feb 26; 323(8). PMID: 32096852    Free PMC article.
Abbreviated Magnetic Resonance Imaging for Breast Cancer Screening: Concept, Early Results, and Considerations.
Eun Sook Ko, Elizabeth A Morris.
Korean J Radiol, 2019 Mar 20; 20(4). PMID: 30887736    Free PMC article.
Changing Paradigms in Breast Cancer Screening: Abbreviated Breast MRI.
Ann R Mootz, Ananth J Madhuranthakam, Başak Doğan.
Eur J Breast Health, 2019 Mar 01; 15(1). PMID: 30816364    Free PMC article.
Integrated Multiparametric Radiomics and Informatics System for Characterizing Breast Tumor Characteristics with the OncotypeDX Gene Assay.
Michael A Jacobs, Christopher B Umbricht, +5 authors, Antonio C Wolff.
Cancers (Basel), 2020 Oct 01; 12(10). PMID: 32992569    Free PMC article.
Optimal Screening in Breast Cancer Survivors With Dense Breasts on Mammography.
Habib Rahbar, Janie M Lee, Christoph I Lee.
J Clin Oncol, 2020 Jul 25; 38(33). PMID: 32706641    Free PMC article.
Abbreviated breast MRI for screening women with dense breast: the EA1141 trial.
Christiane K Kuhl.
Br J Radiol, 2017 Jul 28; 91(1090). PMID: 28749202    Free PMC article.
Why the Gold Standard Approach by Mammography Demands Extension by Multiomics? Application of Liquid Biopsy miRNA Profiles to Breast Cancer Disease Management.
Pavol Zubor, Peter Kubatka, +17 authors, Olga Golubnitschaja.
Int J Mol Sci, 2019 Jun 16; 20(12). PMID: 31200461    Free PMC article.