Breast cancer in women after withdrawing from an increased-risk MRI screening program

Objective: 

This study evaluates breast cancer (BC) detection in women with ≥ 20% lifetime risk who discontinued annual breast MRI screening surveillance. 

Materials and methods: 

This retrospective single screening cohort (2003–2019) study included 3308 women who received at least one breast MRI. After verifying with the Netherlands Comprehensive Cancer Organization (IKNL), a sub-population of women who developed BC after discontinuation was identified. Screening indications, BC incidence rates, tumor characteristics, and reasons for MRI screening discontinuation were compared between women who continued and those who discontinued MRI screening using descriptive and inferential methods. 

Results: 

Among 3308 participants, 2647 discontinued MRI screening. After discontinuation, 58/2647 (2.2%) developed BC (43 invasive, 13 DCIS, 2 NA). Initial screening indications included: personal (26/58, 44.8%) or family history (17/58, 29.3%) of BC, BRCA1 (3/58, 5.2%), BRCA2 (1/58, 1.7%), chest irradiation (1/58, 1.7%), other mutations (2/58, 3.4%) and other (8/58, 13.8%). Of these, 27 continued mammography screening, detecting 23 BC-cases. Discontinuation was mainly physician-driven. Invasive tumor size after cessation of MRI screening tended to be larger compared to tumors detected while participating in MRI screening (median difference: 7.0 mm, 95% CI: 4.0–10.0, p < 0.001). Mean age at diagnosis was 58. Median time from last MRI to diagnosis was 5.9 years. 

Conclusion: 

Women with a personal or family history of BC commonly discontinued MRI screening, often influenced by referring physicians. However, after cessation of MRI screening, a substantial number of these women are still diagnosed with BC, challenging current MRI screening regulations. Although a last negative MRI appears to reduce the subsequent decade’s likelihood of BC, post-MRI discontinuation detected tumors are prognostically worse, highlighting the need for more personalized, extended screening. Key Points: Question Current regulations and duration of MRI screening do not suit the entire increased-risk population. Findings Early discontinuation disproportionately affects women with a personal or family history. Cancers detected after cessation of MRI screening seem larger and more often invasive. Clinical relevance Because certain women with a personal or family risk indication could benefit from a longer duration of MRI screening, extended, personalized screening beyond current guidelines is suggested.