A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer

Lord, S.J.; Lei, W.; Craft, P.; Cawson, J.N.; Morris, I.; Walleser, S.; Griffiths, A.; Parker, S.; Houssami, N.

doi:10.1016/j.ejca.2007.06.007

« Previous Next »European Journal of Cancer
Volume 43, Issue 13 , Pages 1905-1917, September 2007

A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer

S.J. Lord
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia
- Corresponding author: Tel.: +61 2 9563 5322; fax: +61 2 9565 1863.
W. Lei
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia
P. Craft
- Medical Oncology Unit, The Canberra Hospital, Yamba Drive, Woden, Australian Capital Territory 2605, Australia
- Academic Unit of Internal Medicine, Australian National University Medical School, Frank Fenner Building 42, Canberra Australian Capital Territory 0200, Australia
J.N. Cawson
- St Vincents Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia
I. Morris
- Department of Diagnostic Imaging, Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Subiaco, Western Australia 6008, Australia
S. Walleser
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia
A. Griffiths
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia
S. Parker
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia
N. Houssami
- Screening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, A27, Sydney, New South Wales 2006, Australia

Received 1 May 2007; received in revised form 9 June 2007; accepted 20 June 2007. published online 03 August 2007.

Abstract

Breast magnetic resonance imaging (MRI) has been proposed as an additional screening test for young women at high risk of breast cancer in whom mammography alone has poor sensitivity. We conducted a systematic review to assess the effectiveness of adding MRI to mammography with or without breast ultrasound and clinical breast examination (CBE) in screening this population. We found consistent evidence in 5 studies that adding MRI provides a highly sensitive screening strategy (sensitivity range: 93–100%) compared to mammography alone (25–59%) or mammography plus ultrasound+/−CBE (49–67%). Meta-analysis of the three studies that compared MRI plus mammography versus mammography alone showed the sensitivity of MRI plus mammography as 94% (95%CI 86–98%) and the incremental sensitivity of MRI as 58% (95%CI 47–70%). Incremental sensitivity of MRI was lower when added to mammography plus ultrasound (44%, 95%CI 27–61%) or to the combination of mammography, ultrasound plus CBE (31–33%). Estimates of screening specificity with MRI were less consistent but suggested a 3–5-fold higher risk of patient recall for investigation of false positive results. No studies assessed as to whether adding MRI reduces patient mortality, interval or advanced breast cancer rates, and we did not find strong evidence that MRI leads to the detection of earlier stage disease. Conclusions about the effectiveness of MRI therefore depend on assumptions about the benefits of early detection from trials of mammographic screening in older average risk populations. The extent to which high risk younger women receive the same benefits from early detection and treatment of MRI-detected cancers has not yet been established.