Effective Surveillance of High-Risk Women

Clin Breast Cancer. 2022 Apr;22(3):e263-e269. doi: 10.1016/j.clbc.2021.07.014. Epub 2021 Jul 27.


Background: This study addresses the effectiveness of risk models and screening breast magnetic resonance imaging (MRI) in women who have atypical hyperplasia (AH), lobular carcinoma in situ (LCIS), or a family history of breast cancer, but not a genetic mutation.

Patients and methods: A retrospective review of 444 women who had 458 breast screening MRIs at a community teaching hospital over a 12-month period between March 25, 2014 and March 31, 2015 was performed. The patients underwent high risk screening with breast MRIs alternating with mammograms every 6 months. After excluding patients with prior breast or ovarian cancer, genetic mutations, and chest wall radiation, 200 remaining patients constituted the study cohort. Over the following 5 years, the patients were screened with MRIs alternating with mammograms every 6 months. A total of 961 total MRI screenings were performed over the entire 5-year period of the study.

Results: A total of 200 women fit the study criteria. Of these 103 had a prior history of AH or LCIS. Over the 5-year period, 60 women dropped out of the screening regimen, 6 patients were diagnosed with breast cancer on screening MRIs, and 2 additional patients were diagnosed with breast cancer on screening mammograms. Surprisingly, the highest Tyrer-Cuzick (T-C) scores did not correlate with increased development of breast cancers in our population.

Conclusions: This study shows that there is wide variation in the results of risk assessment models. Risk models may overestimate breast cancer risk, suggesting that re-evaluation of current risk assessment and screening protocols is warranted.

Keywords: Atypical ductal hyperplasia; Atypical lobular hyperplasia; Breast cancer surveillance; High risk population; Lobular carcinoma in situ; Risk models.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast / diagnostic imaging
  • Breast Carcinoma In Situ*
  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / epidemiology
  • Female
  • Humans
  • Hyperplasia
  • Male
  • Mammography
  • Ovarian Neoplasms*