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Original Investigation
June 22, 2017

Breast Cancer Screening With Mammography Plus Ultrasonography or Magnetic Resonance Imaging in Women 50 Years or Younger at Diagnosis and Treated With Breast Conservation Therapy

Author Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 2Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  • 4Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  • 5Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 6Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 7Department of Radiology, College of Medicine, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
  • 8Department of General Surgery, College of Medicine, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
  • 9Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 10Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 11Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Republic of Korea
  • 12Department of Surgery, Seoul National University Bundang Hospital, Bundang, Republic of Korea
  • 13Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
JAMA Oncol. Published online June 22, 2017. doi:10.1001/jamaoncol.2017.1256
Key Points

Question  What are the screening yield and tumor characteristics detected by combined mammography and magnetic resonance imaging (MRI) or ultrasonography in women diagnosed at 50 years or younger who underwent breast conservation and radiotherapy for breast cancer?

Findings  In this multicenter comparison study of 754 women, MRI screening detected 3.8 additional cancers and ultrasonography detected 2.4 additional cancers, most of which were stage 0 or stage 1, per 1000 women and increased sensitivity over mammography alone.

Meaning  In younger women who had undergone breast conservation therapy, the addition of MRI screening or ultrasonography to mammography can be considered.

Abstract

Importance  Younger women (aged ≤50 years) who underwent breast conservation therapy may benefit from breast magnetic resonance imaging (MRI) screening as an adjunct to mammography.

Objective  To prospectively determine the cancer yield and tumor characteristics of combined mammography with MRI or ultrasonography screening in women who underwent breast conservation therapy for breast cancers and who were 50 years or younger at initial diagnosis.

Design, Setting, and Participants  This multicenter, prospective, nonrandomized study was conducted from December 1, 2010, to January 31, 2016, at 6 academic institutions. Seven hundred fifty-four women who were 50 years or younger at initial diagnosis and who had undergone breast conservation therapy for breast cancer were recruited to participate in the study. Reference standard was defined as a combination of pathology and 12-month follow-up.

Interventions  Participants underwent 3 annual MRI screenings of the conserved and contralateral breasts in addition to mammography and ultrasonography, with independent readings.

Main Outcomes and Measures  Cancer detection rate, sensitivity, specificity, interval cancer rate, and characteristics of detected cancers.

Results  A total of 754 women underwent 2065 mammograms, ultrasonography, and MRI screenings. Seventeen cancers were diagnosed, and most of the detected cancers (13 of 17 [76%]) were stage 0 or stage 1. Overall cancer detection rate (8.2 vs 4.4 per 1000; P = .003) or sensitivity (100% vs 53%; P = .01) of mammography with MRI was higher than that of mammography alone. After the addition of ultrasonography, the cancer detection rate was higher than that by mammography alone (6.8 vs 4.4 per 1000; P = .03). The specificity of mammography with MRI or ultrasonography was lower than that by mammography alone (87% or 88% vs 96%; P < .001). No interval cancer was found.

Conclusions and Relevance  After breast conservation therapy in women 50 years or younger, the addition of MRI to annual mammography screening improves detection of early-stage but biologically aggressive breast cancers at acceptable specificity. Results from this study can inform patient decision making on screening methods after breast conservation therapy.

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