Magnetic resonance imaging improves breast screening sensitivity in BRCA mutation carriers age ≥ 50 years : evidence from an individual patient data meta-analysis

X.A. Phi, N. Houssami, I.M. Obdeijn, E. Warner, F. Sardanelli, M.O. Leach, C.C. Riedl, I. Trop, M.M.A. Tilanus-Linthorst, R. Mandel, F. Santoro, G. Kwan-Lim, T.H. Helbich, H.J. Koning, de, E.R. Heuvel, van den, G.H. Bock, de

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Abstract

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.
Original languageEnglish
Pages (from-to)349-356
JournalJournal of Clinical Oncology
Volume33
Issue number4
DOIs
Publication statusPublished - 2015
Externally publishedYes

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