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Meta-Analysis
. 2016 Mar 15;114(6):631-7.
doi: 10.1038/bjc.2016.32. Epub 2016 Feb 23.

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis

Xuan-Anh Phi  1 , Sepideh Saadatmand  2 , Geertruida H De Bock  1 , Ellen Warner  3 , Francesco Sardanelli  4 , Martin O Leach  5 , Christopher C Riedl  6 , Isabelle Trop  7 , Maartje J Hooning  8 , Rodica Mandel  3 , Filippo Santoro  9 , Gek Kwan-Lim  5 , Thomas H Helbich  6 , Madeleine M A Tilanus-Linthorst  10 , Edwin R van den Heuvel  11 , Nehmat Houssami  12
Affiliations
Meta-Analysis

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis

Xuan-Anh Phi et al. Br J Cancer. .

Abstract

Background: We investigated the additional contribution of mammography to screening accuracy in BRCA1/2 mutation carriers screened with MRI at different ages using individual patient data from six high-risk screening trials.

Methods: Sensitivity and specificity of MRI, mammography and the combination of these tests were compared stratified for BRCA mutation and age using generalised linear mixed models with random effect for studies. Number of screens needed (NSN) for additional mammography-only detected cancer was estimated.

Results: In BRCA1/2 mutation carriers of all ages (BRCA1 = 1,219 and BRCA2 = 732), adding mammography to MRI did not significantly increase screening sensitivity (increased by 3.9% in BRCA1 and 12.6% in BRCA2 mutation carriers, P > 0.05). However, in women with BRCA2 mutation younger than 40 years, one-third of breast cancers were detected by mammography only. Number of screens needed for mammography to detect one breast cancer not detected by MRI was much higher for BRCA1 compared with BRCA2 mutation carriers at initial and repeat screening.

Conclusions: Additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers, whereas mammography contributes to screening sensitivity in BRCA2 mutation carriers, especially those ⩽ 40 years. The evidence from our work highlights that a differential screening schedule by BRCA status is worth considering.

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Conflict of interest statement

The following authors reported consulting or advisory roles: Thomas H Helbich (Siemens; Philips); Francesco Sardanelli (Bayer HealthCare including honoraria; Bracco Imaging including funding; IMS-Giotto including funding); Edwin R van den Heuvel (MSD). The other authors declare no conflict of interest.

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