scholarly journals Performance Measures of Magnetic Resonance Imaging Plus Mammography in the High Risk Ontario Breast Screening Program

2019 ◽  
Vol 112 (2) ◽  
pp. 136-144 ◽  
Author(s):  
Anna M Chiarelli ◽  
Kristina M Blackmore ◽  
Derek Muradali ◽  
Susan J Done ◽  
Vicky Majpruz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Breast Screening ◽  
Screening Program ◽  
Breast Cancers ◽  
Resonance Imaging ◽  
High Risk Women ◽  
Mutation Carriers

Abstract Background The Ontario Breast Screening Program expanded in July 2011 to screen high-risk women age 30–69 years with annual magnetic resonance imaging (MRI) and digital mammography. This study examined the benefits of screening with mammography and MRI by age and risk criteria. Methods This prospective cohort study included 8782 women age 30–69 years referred to the High Risk Ontario Breast Screening Program from July 2011 to June 2015, with final results to December 2016. Cancer detection rates, sensitivity, and specificity of MRI and mammography combined were compared with each modality individually within risk groups stratified by age using generalized estimating equation models. Prognostic features of screen-detected breast cancers were compared by modality using Fisher exact test. All P values are two-sided. Results Among 20 053 screening episodes, there were 280 screen-detected breast cancers (cancer detection rate = 14.0 per 1000, 95% confidence interval [CI] = 12.4 to 15.7). The sensitivity of mammography was statistically significantly lower than that of MRI plus mammography (40.8%, 95% CI = 29.3% to 53.5% vs 96.0%, 95% CI = 92.2% to 98.0%, P < .001). In mutation carriers age 30–39 years, sensitivity of the combination was comparable with MRI alone (100.0% vs 96.8%, 95% CI = 79.2% to 100.0%, P = .99) but with statistically significantly decreased specificity (78.0%, 95% CI = 74.7% to 80.9% vs 86.2%, 95% CI = 83.5% to 88.5%, P < .001). In women age 50–69 years, combining MRI and mammography statistically significantly increased sensitivity compared with MRI alone (96.3%, 95% CI = 90.6% to 98.6% vs 90.9%, 95% CI = 83.6% to 95.1%, P = .02), with a small but statistically significant decrease in specificity (84.2%, 95% CI = 83.1% to 85.2% vs 90.0%, 95% CI = 89.2% to 90.9%, P < .001). Conclusions Screening high risk women age 30–39 years with annual MRI only may be sufficient for cancer detection and should be evaluated further, particularly for mutation carriers. Among women age 50–69 years, detection is most effective when mammography is included with annual MRI.

Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program

2014 ◽  
Vol 32 (21) ◽  
pp. 2224-2230 ◽  
Author(s):  
Anna M. Chiarelli ◽  
Maegan V. Prummel ◽  
Derek Muradali ◽  
Vicky Majpruz ◽  
Meaghan Horgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Gene Mutation ◽  
Breast Screening ◽  
Screening Program ◽  
Resonance Imaging ◽  
Mutation Carriers ◽  
Increased Risk

Purpose The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer. Patients and Methods Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously). Results The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%). Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.

scholarly journals Breast screening with magnetic resonance imaging in high-risk women

2012 ◽  
Vol 14 (S1) ◽  
Author(s):  
L McLean ◽  
F Douglas ◽  
N Forester ◽  
CE Holmes
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Breast Screening ◽  
Resonance Imaging ◽  
High Risk Women

scholarly journals Foci on breast magnetic resonance imaging in high-risk women: cancer or not?

2016 ◽  
Vol 121 (8) ◽  
pp. 611-617 ◽  
Author(s):  
Paola Clauser ◽  
Enrico Cassano ◽  
Arianna De Nicolò ◽  
Anna Rotili ◽  
Bernardo Bonanni ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Breast Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
High Risk Women ◽  
Breast Magnetic Resonance

scholarly journals The relationship of breast density in mammography and magnetic resonance imaging in high-risk women and women with breast cancer

2015 ◽  
Vol 39 (6) ◽  
pp. 987-992 ◽  
Author(s):  
Marissa Albert ◽  
Freya Schnabel ◽  
Jennifer Chun ◽  
Shira Schwartz ◽  
Jiyon Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Breast Density ◽  
Resonance Imaging ◽  
High Risk Women ◽  
Relationship Of ◽  
The Relationship

Magnetic Resonance Imaging Improves Breast Screening Sensitivity in BRCA Mutation Carriers Age ≥ 50 Years: Evidence From an Individual Patient Data Meta-Analysis

2015 ◽  
Vol 33 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Xuan-Anh Phi ◽  
Nehmat Houssami ◽  
Inge-Marie Obdeijn ◽  
Ellen Warner ◽  
Francesco Sardanelli ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Breast Screening ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Random Effect ◽  
Patient Data ◽  
Resonance Imaging ◽  
Mutation Carriers ◽  
Screening Sensitivity

Purpose There is no consensus on whether magnetic resonance imaging (MRI) should be included in breast screening protocols for women with BRCA1/2 mutations age ≥ 50 years. Therefore, we investigated the evidence on age-related screening accuracy in women with BRCA1/2 mutations using individual patient data (IPD) meta-analysis. Patients and Methods IPD were pooled from six high-risk screening trials including women with BRCA1/2 mutations who had completed at least one screening round with both MRI and mammography. A generalized linear mixed model with repeated measurements and a random effect of studies estimated sensitivity and specificity of MRI, mammography, and the combination in all women and specifically in those age ≥ 50 years. Results Pooled analysis showed that in women age ≥ 50 years, screening sensitivity was not different from that in women age < 50 years, whereas screening specificity was. In women age ≥ 50 years, combining MRI and mammography significantly increased screening sensitivity compared with mammography alone (94.1%; 95% CI, 77.7% to 98.7% v 38.1%; 95% CI, 22.4% to 56.7%; P < .001). The combination was not significantly more sensitive than MRI alone (94.1%; 95% CI, 77.7% to 98.7% v 84.4%; 95% CI, 61.8% to 94.8%; P = .28). Combining MRI and mammography in women age ≥ 50 years resulted in sensitivity similar to that in women age < 50 years (94.1%; 95% CI, 77.7% to 98.7% v 93.2%; 95% CI, 79.3% to 98%; P = .79). Conclusion Addition of MRI to mammography for screening BRCA1/2 mutation carriers age ≥ 50 years improves screening sensitivity by a magnitude similar to that observed in younger women. Limiting screening MRI in BRCA1/2 carriers age ≥ 50 years should be reconsidered.

Implementation of a population-based breast screening program for high-risk women in Ontario: The Ontario Breast Screening Program (OBSP) High-Risk Program.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12034-e12034
Author(s):  
Andrea Eisen ◽  
June Carroll ◽  
Anna M. Chiarelli ◽  
Esti Heale ◽  
Meaghan Horgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Breast Screening ◽  
Screening Program ◽  
Primary Care Providers ◽  
Population Based ◽  
High Risk Women ◽  
Mutation Carriers ◽  
Organized Screening Program

e12034 Background: Genetic testing for mutations in BRCA1 and BRCA2 has been clinically available in Ontario since 2000. It is estimated that over 15000 individuals have been tested. Evidence from clinical trials have consistently shown that women at high risk of breast cancer such as BRCA1/2 mutation carriers benefit from breast cancer screening that includes both magnetic resonance imaging (MRI) of the breast and mammography, yet access to MRI in Ontario was variable. In 2011, Cancer Care Ontario established an expert panel to develop a protocol for expanding the Ontario Breast Screening Program, initially created for average risk women 50-74, to include MRI and mammography for eligible high risk women. Methods: The panel’s tasks included: 1. determining the criteria for high risk, 2. estimating the prevalence of high risk women, 3. selecting a model to estimate cancer risk, 4. developing a referral and assessment pathway for potentially eligible subjects to receive genetic counseling/risk assessment and screening if eligible, 5. developing educational resources, training plan and communication strategy for relevant stakeholders including primary care providers, oncologists, geneticists and genetic counselors, 6. developing indicators to permit program evaluation, 7. providing guidance for post-implementation issues such as subject eligibility and interpretation of genetic test results. Results: The program was initiated July, 2011 at 19 sites. Women aged 30-69 with and without a history of breast cancer are eligible if they 1. are BRCA1/2 mutation carriers or untested first degree relatives of carriers, 2. have a lifetime risk of breast cancer >=25% based on family history, or 3. received prior radiation therapy to the chest. It is estimated that 34000 high risk women in the target age group live in Ontario. Conclusions: A population based organized screening program for high risk women that includes genetic risk assessment has been implemented in Ontario. To our knowledge, this is the first organized screening program for women at high risk of breast cancer.

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