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February 23, 2005

Surveillance of

JAMA. 2005;293(8):931. doi:10.1001/jama.293.8.931-a

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.

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