To the Editor: The study by Dr Warner and colleagues1 comparing magnetic resonance imaging (MRI), mammography,
ultrasound, and clinical breast examination in screening BRCA1 and BRCA2 carriers for breast cancer
has several potential limitations that could affect their conclusions.
First, the study compared prevalent cancer screening by MRI with incident
cancer screening by mammography. This may bias against mammography since prevalent
screening generally detects more cancer than incident screening. The sensitivity
of MRI in prevalent screen 1 was better than its performance in subsequent
incident screens, with sensitivity decreasing from 85% to 71% and 50% on annual
screens 1, 2, and 3, respectively. This same pattern was observed by Kriege
et al2 with MRI sensitivity decreasing from
79% at screen 1 to 62% at screen 2.
Helvie M. Surveillance of. JAMA. 2005;293(8):931. doi:10.1001/jama.293.8.931-a
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