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, XA
AU - Houssami, N
AU - Obdeijn, Inge-marie
AU - Warner, E
AU - Sardanelli, F
AU - Leach, MO
AU - Riedl, CC
AU - Trop, I
AU - Tilanus - Linthorst, Madeleine
AU - Mandel, R
AU - Santoro, F
AU - Kwan-Lim, G
AU - Helbich, TH
AU - de Koning, Harry
AU - van den Heuvel, ER
AU - de Bock, GH
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. (C) 2014 by American Society of Clinical Oncology
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. (C) 2014 by American Society of Clinical Oncology
U2 - 10.1200/JCO.2014.56.6232
DO - 10.1200/JCO.2014.56.6232
M3 - Article
C2 - 25534390
SN - 0732-183X
VL - 33
SP - 349
EP - 356
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -