Magnetic Resonance Imaging Improves Breast Screening Sensitivity in BRCA Mutation Carriers Age >= 50 Years: Evidence From an Individual Patient Data Meta-Analysis

XA Phi, N Houssami, Inge-marie Obdeijn, E Warner, F Sardanelli, MO Leach, CC Riedl, I Trop, Madeleine Tilanus - Linthorst, R Mandel, F Santoro, G Kwan-Lim, TH Helbich, Harry de Koning, ER van den Heuvel, GH de Bock

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Abstract

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
Original languageUndefined/Unknown
Pages (from-to)349-356
Number of pages8
JournalJournal of Clinical Oncology
Volume33
Issue number4
DOIs
Publication statusPublished - 2015

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