Women with personal history of breast cancer should be screened with MRI

November 29, 2010, Radiological Society of North America

Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

The American Cancer Society (ACS) guidelines currently recommend annual screening with breast MRI in with a known gene mutation or with a strong indicating a lifetime risk of greater than 20 percent. However, the guidelines say there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer themselves.

"In our study using breast MRI screening, we actually detected proportionally more cancers in women with a personal history of breast cancer, compared with those women with a genetic mutation or strong family history who are currently recommended to have breast MRI," said Wendy B. DeMartini, M.D., assistant professor in the Department of Radiology at the University of Washington Medical Center and Seattle Cancer Care Alliance in Seattle. "Further, women with a personal history were less likely to be recalled for additional testing and less likely to have a biopsy for a false positive MRI finding."

Dr. DeMartini and colleagues performed a retrospective review of initial screening breast MRI examinations of 1,026 women from January 2004 to June 2009. Of the 1,026 women, 327 had a genetic or family history of breast cancer and 646 had a personal history of treated breast cancer.

Overall, MRI testing identified 25 of 27 cancers in the group for a sensitivity rate of 92.6 percent.

The cancer yield in the women with a personal history of breast cancer (3.1 percent) was double that of the women with a genetic or family history (1.5 percent). Specificity in women with a personal history was 93.6 percent, compared with 86.3 percent for the other group. Specificity refers to the accuracy of the exam in correctly ruling out cancer where it is not present, resulting in lower recall and biopsy rates due to false-positive findings.

Biopsy was recommended in 9.3 percent of the women with a personal history of breast cancer, compared with 15 percent of the genetic and family history group. The positive predictive value of biopsy was also higher in the personal history group, with 35.7 percent of biopsies yielding cancer, compared with only 12.2 percent in the other group.

"Our findings show that the diagnostic performance of MRI in patients with a personal history of treated breast cancer supports consideration of screening MRI as an adjunct to mammography," Dr. DeMartini said. "Additional studies such as ours are necessary to establish guidelines for screening this important group of women."

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geokstr
1 / 5 (1) Nov 29, 2010
Hey, just came up with a solution to lower the "cost curve" for health care and take a bite out of terrorism at the same time.

We just have the Department of Health and Human Services take over the TSA. Then we can have mandatory mammograms, prostate exams, pap smears, colorectal cancer tests, and testing for STDs right at the airport at the same time we're looking for bombs. And that gives us an way to make sure that certain orifices are not being used to conceal the WMD, given that the scanners can't spot that.

Now we'll have to just mandate a requirement that all persons in America fly at least once every year as a condition of citizenship or residency.

What a concept.

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