MRI More Effective than Mammography for BRCA1/BRCA2 Carriers

MRI More Effective than Mammography for BRCA1/BRCA2 Carriers

According to a recent article published in the Journal of the American Medical Association , magnetic resonance imaging (MRI) is more effective at detecting breast cancer than screening mammography in women who carry the BRCA1 or BRCA2 genetic mutations.[1]

Breast cancer is diagnosed in approximately 250,000 women annually in the United States. A small portion of these patients have genetic mutations that put them at a higher than normal risk for the development of breast cancer. These patients often undergo regular screening in order to detect the cancer early, when it is most treatable. Individuals with strong family histories and/or mutations within the BRCA1 or BRCA2 genes have a high risk of developing breast cancer within their lifetime. Women with these mutations have to make a decision as to whether preventive surgery or frequent monitoring for the development of breast cancer will provide the most reassuring option for them. Self breast exams, mammography and ultrasound imaging are all frequently used for monitoring of breast cancer. However, since young women have more dense breasts, mammography often cannot pick up small cancers. Results from previous trials have indicated that MRI is more accurate than mammography in the detection of breast cancer and researchers continue to evaluate which screening method detects the most cases of breast cancer while providing accurate readings.[2],[3]

Researchers from Canada recently conducted a clinical trial to compare different screening methods for the detection of breast cancer in women with BRCA1 and BRCA2 mutations. The study included 236 women who underwent screening with mammography, ultrasound, MRI and clinical breast examination between 1997 and 2003. During the time of the study, 22 breast cancers were detected. MRI detected 77% of the cancers, compared to only a 36% detection rate by mammography and a 33% detection rate by ultrasound. Only 9.1% of cancers were detected by clinical breast examination. All four examination methods used together resulted in a 95% detection rate of the breast cancers.

The researchers concluded that MRI appears to be the most effective, single screening procedure for the detection of breast cancer in patients who have BRCA1 or BRCA2 mutations. These results are consistent with results from other trials also indicating that MRI appears to be more effective at detecting breast cancers than mammography in this group of patients. It is important that patients who have the BRCA1 or BRCA2 mutations speak with their physician about types of screening procedures, as well as frequency of lifelong screening.

References:

[1] 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. Journal of the American Medical Association . 2004;292:1317-1325.

[2] Kuhl CK, Schrading S, Leutner CC, et al. surveillance of High-Risk women with proven or suspected familial (hereditary) breast cancer: First midterm results of a multi-modality clinical screening trial. Proceedings of the 39th meeting of the American Society of Oncology. 2003;22:abstract 4, page 2.

[3] Kriege M, Brekelmans CTM, Boetes, et al. Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. The New England Journal of Medicine . 2004;351:427-437.

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