> Table 32: MRI plus mammography versus mammography alone in high-risk women
This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.
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Introduction: Magnetic resonance imaging (MRI) uses magnetic fields to create an image of the breast.
MRI in combination with mammography for women at high risk of breast cancer
There is growing evidence that MRI in combination with mammography, compared to mammography alone, can increase detection of cancer in certain women at higher risk of breast cancer. The American Cancer Society now recommends considering MRI as part of a breast cancer screening plan for women who have one or both of these risk factors [1]:
- BRCA1 or BRCA2 gene mutation
- Strong family history of breast cancer
Drawbacks to MRI as a screening tool
Screening MRI has some drawbacks compared to standard mammography. It is more invasive than mammography because a contrast agent must be injected before the procedure. And, not every center doing MRI has the proper equipment for making a good image of the breast or the radiologists trained to read them. It is expensive (and not always covered by insurance) and has more false positive results.
Learn more about false positive results.
MRI in combination with mammography for women at average risk of breast cancer
While MRI along with mammography may offer some benefit to women at higher risk of breast cancer, it is not recommended for routine breast cancer screening for women at average risk.
Learn more about MRI and mammography.
Study measures (sensitivity and specificity)
The main goal of any cancer screening test is to identify correctly those people who have cancer (called the sensitivity of the test). When sensitivity is high, very few cases are missed. However, this means some healthy people will be misidentified as having cancer (a false positive result). For example, a sensitivity of 90 percent means that 90 percent of people tested who truly have cancer are correctly identified as having cancer.
An ideal cancer screening test would also be able to identify correctly all the people who do not have cancer as not having it (called the specificity of the test). When specificity is high, there are fewer false positive results, but more cases of true cancer are missed. For example, a specificity of 90 percent means that 90 percent of the people who are healthy are correctly identified as not having cancer.
No screening test has perfect sensitivity and perfect specificity. There is a trade-off between the two for all types of screening tests. That is, when a test gains sensitivity, it loses some specificity.
Learn more about the quality of screening tests.
Study selection criteria: Clinical studies and meta-analyses of women at high risk for breast cancer (defined as either having a BRCA1 or BRCA2 mutation or having a family history suggesting a BRCA1 or BRCA2 mutation) with at least 20 invasive breast cancer cases.
Table note: The studies presented below compare quality measures for screening with standard film mammography alone, MRI alone and MRI in combination with mammography. At this time, there are no data comparing survival among women who have standard film mammography alone versus those who have MRI plus standard mammography.
Study
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Study Population*
(number of participants)
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Sensitivity
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Specificity
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Mammography
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MRI
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Mammography
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MRI
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Clinical studies
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Kriege et al. [2]
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1,909
(51 cases)
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40%†
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71%†
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95%
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90%
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Kuhl et al. [3]
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529
(43 cases)
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32.6%
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90.7%
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96.8%
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97.2%
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Leach et al. [4]
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649
(35 cases)
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40%
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77%
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93%
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81%
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Hagen et al. [5]
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491
(25 cases)
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50%
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86%
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N/A
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N/A
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Warner et al. [6]
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236
(22 cases)
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38%
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85%
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99.6%
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93%
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Meta-analyses
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Warner et al. [7]
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11 studies
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32%
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75%
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98.5%
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96.1%
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Granader et al. [8]
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8 studies
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37.5%
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96.6%
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95.9%
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90.5%
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Study
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Study Population*
(number of participants)
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MRI plus Mammography
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Sensitivity
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Specificity
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Clinical studies
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Kuhl et al. [3]
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529
(43 cases)
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93.0%
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96.1%
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Leach et al. [4]
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649
(35 cases)
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94%
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77%
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Meta-analyses
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Warner et al. [7]
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11 studies
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84.0%
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95.2%
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Granader et al. [8]
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8 studies
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94.4%
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86.2%
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N/A = Results not available.
* Most study results combine cases of invasive breast cancer and ductal carcinoma in situ. All studies include at least 20 cases of invasive breast cancer.
† Sensitivities for invasive cancers only were 33% for mammography and 80% for MRI.
References
- Saslow D, Boetes C, Burke W, et al. for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 57(2):75-89, 2007.
- Kriege M, Brekelmans CTM, Boetes C, et al. for the Magnetic Resonance Imaging Screening Study Group. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 351(5):427-37, 2004.
- Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 23(33):8469-76, 2005.
- Leach MO, Boggis CR, Dixon AK, et al. for the MARIBS Study Group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 365(9473):1769-78, 2005.
- Hagen AI, Kvistad KA, Maehle L, et al. Sensitivity of MRI versus conventional screening in the diagnosis of BRCA-associated breast cancer in a national prospective series. Breast. 16(4):367-74, 2007.
- Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 292(11):1317-25, 2004.
- Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 148(9):671-9, 2008.
- Granader EJ, Dwamena B, Carlos RC. MRI and mammography surveillance of women at increased risk for breast cancer: recommendations using an evidence-based approach. Acad Radiol. 15(12):1590-5, 2008.
Updated 05/25/11
