Review articleMRI and Mammography Surveillance of Women at Increased Risk for Breast Cancer: Recommendations Using an Evidence-based Approach
Section snippets
Materials and methods
The MEDLINE, PubMed, EBM Reviews, ACP Journal Club, Cochrane Database MEDSEARCH, and SCOPUS databases were accessed and searched for articles up to August 2007. Articles were collected using the following terms and medical subject headings (MeSH) that applied to the focused clinical question: “BRCA1” and “BRCA2” with “mammography,” “MRI,” “prevention,” “screening,” and “surveillance.” References from retrieved articles were also used to identify relevant papers.
The abstracts of articles
Results
Study level data of reported performance characteristics of screening by MRI alone (Table 1), mammography alone (Table 2), and a combination of MRI and mammography (Table 3) are summarized. To derive summary performance characteristics, initially, all studies were aggregated. Four of the eight studies identified did not segregate women by BRCA 1/2 mutation status, therefore, summary performance is reported for all patients (Table 4). Aggregating across studies, screening by MRI alone had the
Discussion
Combining the data for the current best evidence from three prospective level 2 diagnostic studies using a standard meta-analysis technique demonstrates that both MRI alone and the combination of MRI and mammography have much greater sensitivities than mammography alone. This is true in women with strong family histories for breast cancer and for women who are BRCA 1/2 positive. When looking at the summary performances for false-positive rates, although mammography alone had the lowest false
Conclusion
Currently, no mortality benefit has been demonstrated from screening women with BRCA mutations, and without long-term follow up it is impossible to assess disease status years later in these higher risk women. However, our analysis of the current best evidence demonstrates that MRI, when available, should play a primary role in the imaging surveillance of women at high risk for breast cancer.
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