• DOI:10.1200/JCO.2013.52.8331
• Corpus ID: 24899539

Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screen from the ontario high risk breast screening program.

@article{Chiarelli2014EffectivenessOS,
  title={Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screen from the ontario high risk breast screening program.},
  author={Anna M. Chiarelli and Maegan V. Prummel and Derek Muradali and Vicky Majpruz and Meaghan Horgan and June C. Carroll and Andrea Eisen and Wendy S. Meschino and R. Shumak and Ellen Warner and Linda Rabeneck},
  journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
  year={2014},
  volume={32 21},
  pages={
          2224-30
        }
}

• A. Chiarelli, Maegan V. Prummel, +8 authors L. Rabeneck
• Published 16 June 2014
• Medicine
• Journal of clinical oncology : official journal of the American Society of Clinical Oncology

PURPOSE
The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer.

PATIENTS AND METHODS
Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously).

RESULTS
The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%).

CONCLUSION
Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.