TY - JOUR
T1 - Magnetic resonance imaging improves breast screening sensitivity in BRCA mutation carriers age ≥ 50 years : evidence from an individual patient data meta-analysis
AU - Phi, X.A.
AU - Houssami, N.
AU - Obdeijn, I.M.
AU - Warner, E.
AU - Sardanelli, F.
AU - Leach, M.O.
AU - Riedl, C.C.
AU - Trop, I.
AU - Tilanus-Linthorst, M.M.A.
AU - Mandel, R.
AU - Santoro, F.
AU - Kwan-Lim, G.
AU - Helbich, T.H.
AU - Koning, de, H.J.
AU - Heuvel, van den, E.R.
AU - Bock, de, G.H.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
U2 - 10.1200/JCO.2014.56.6232
DO - 10.1200/JCO.2014.56.6232
M3 - Article
C2 - 25534390
VL - 33
SP - 349
EP - 356
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 4
ER -