Highlights
- •In women at familial risk and no known mutations, we estimate a breast cancer (BC) rate of 12 per 1000 woman-years.
- •BC rate increased from 5.1 per 1000 in women <40 years to 21 per 1000 in women >50 years.
- •Mammography sensitivity ranged from 51% in women <40 to 67% in women ≥50 years.
- •Adjunct magnetic resonance imaging increased sensitivity by 43% but decreased specificity by 15%.
Abstract
Introduction
Women with a strong family history of breast cancer (BC) and without a known gene
mutation have an increased risk of developing BC. We aimed to investigate the accuracy
of screening using annual mammography with or without magnetic resonance imaging (MRI)
for these women outside the general population screening program.
Methods
An individual patient data (IPD) meta-analysis was conducted using IPD from six prospective
screening trials that had included women at increased risk for BC: only women with
a strong familial risk for BC and without a known gene mutation were included in this
analysis. A generalised linear mixed model was applied to estimate and compare screening
accuracy (sensitivity, specificity and predictive values) for annual mammography with
or without MRI.
Results
There were 2226 women (median age: 41 years, interquartile range 35–47) with 7478
woman-years of follow-up, with a BC rate of 12 (95% confidence interval 9.3–14) in
1000 woman-years. Mammography screening had a sensitivity of 55% (standard error of
mean [SE] 7.0) and a specificity of 94% (SE 1.3). Screening with MRI alone had a sensitivity
of 89% (SE 4.6) and a specificity of 83% (SE 2.8). Adding MRI to mammography increased
sensitivity to 98% (SE 1.8, P < 0.01 compared to mammography alone) but lowered specificity
to 79% (SE 2.7, P < 0.01 compared with mammography alone).
Conclusion
In this population of women with strong familial BC risk but without a known gene
mutation, in whom BC incidence was high both before and after age 50, adding MRI to
mammography substantially increased screening sensitivity but also decreased its specificity.
Keywords
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Article info
Publication history
Published online: September 05, 2017
Accepted:
July 29,
2017
Received in revised form:
July 21,
2017
Received:
May 19,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
