MRI for Screening Women with a Personal History of Breast Cancer

Abstract

The American Cancer Society (ACS) and other professional societies recommend the use of magnetic resonance imaging (MRI) as an adjunct to mammography to screen women at high risk for breast cancer. Although women with a previous diagnosis of breast cancer are at increased risk for future breast cancer events, and mammography is less sensitive for the detection of cancer in the post-treatment breast, a personal history of breast cancer (PHBC) is not included among the accepted indications for screening MRI. This is due to a lack of sufficient evidence supporting the use of screening MRI in this specific patient population, in addition to morbidity and cost concerns associated with the work-up of benign lesions identified as suspicious for malignancy on MRI. Since the publication of the ACS guidelines in 2007, 15 studies including 5, 428 women with a PHBC have demonstrated high detection rates for small node-negative invasive cancers and acceptable positive predictive values (PPV) of biopsy with screening MRI. We meta-analyzed those results for cancer detection rate (12 studies), sensitivity (8 studies), and PPV of biopsy prompted by MRI (13 studies). The pooled cancer detection rate was 14 per 1, 000 examinations (95% confidence interval [CI], 10-21‰). The pooled sensitivity was 84% (95% CI, 74-90%). The pooled PPV was 28% (95% CI, 24-33%). Certain subgroups of women with a PHBC, including those who underwent breast-conserving surgery rather than mastectomy and those younger than 50 years at initial cancer diagnosis, are most likely to benefit. Future directions include research on the cost-effectiveness of MRI surveillance in patients with a PHBC, in the absence of BRCA mutations or other high-risk characteristics, and expansion of access to insurance or public health system coverage for screening MRI.