Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)

Lancet. 2005 May 21-27;365(9473):1769-78. doi: 10.1016/S0140-6736(05)66481-1.

Abstract

Background: Women genetically predisposed to breast cancer often develop the disease at a young age when dense breast tissue reduces the sensitivity of X-ray mammography. Our aim was, therefore, to compare contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening.

Methods: We did a prospective multicentre cohort study in 649 women aged 35-49 years with a strong family history of breast cancer or a high probability of a BRCA1, BRCA2, or TP53 mutation. We recruited participants from 22 centres in the UK, and offered the women annual screening with CE MRI and mammography for 2-7 years.

Findings: We diagnosed 35 cancers in the 649 women screened with both mammography and CE MRI (1881 screens): 19 by CE MRI only, six by mammography only, and eight by both, with two interval cases. Sensitivity was significantly higher for CE MRI (77%, 95% CI 60-90) than for mammography (40%, 24-58; p=0.01), and was 94% (81-99) when both methods were used. Specificity was 93% (92-95) for mammography, 81% (80-83) for CE MRI (p<0.0001), and 77% (75-79) with both methods. The difference between CE MRI and mammography sensitivities was particularly pronounced in BRCA1 carriers (13 cancers; 92%vs 23%, p=0.004).

Interpretation: Our findings indicate that CE MRI is more sensitive than mammography for cancer detection. Specificity for both procedures was acceptable. Despite a high proportion of grade 3 cancers, tumours were small and few women were node positive. Annual screening, combining CE MRI and mammography, would detect most tumours in this risk group.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / genetics
  • Carcinoma, Intraductal, Noninfiltrating / diagnosis
  • Carcinoma, Intraductal, Noninfiltrating / genetics
  • Cohort Studies
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Genes, BRCA1
  • Genes, BRCA2
  • Genes, p53
  • Genetic Predisposition to Disease*
  • Humans
  • Magnetic Resonance Imaging*
  • Mammography*
  • Middle Aged
  • Mutation
  • Predictive Value of Tests
  • ROC Curve
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • Gadolinium DTPA