Abbreviated breast MRI for screening women with dense breast: the EA1141 trial

Abstract

Early diagnosis improves survival of females with breast cancer. Mammographic screening improves early diagnosis of breast cancer. And yet, there appears to be room for improvement. Major shortcomings of mammographic screening are overdiagnosis of prognostically unimportant cancer, as well as underdiagnosis of cancers that are indeed relevant. Failure to detect biologically relevant breast cancer with mammographic screening is driven not only by host-related factors, i.e. breast tissue density, but also by tumour-related factors: Biologically relevant cancers may exhibit imaging features that render them indistinguishable from normal or benign breast tissue on mammography. These cancers will then progress to become the advanced-stage interval cancers observed in females undergoing mammographic screening. Since breast cancer continues to represent a major cause of cancer death in females, the search for improved breast cancer screening method continues. Abbreviated breast MRI has been proposed for this purpose because it will greatly reduce the cost associated with this method, due to a greatly reduced magnet time (down to 3 min), but especially also due to a greatly abridged image interpretation time, i.e. radiologist reading time. This commentary reviews the current situation and presents the EA1141 trial designed to investigate the utility of abbreviated breast MRI for screening average-risk females with dense breast tissue.

Figure 1.

(a) C-view of a breast tomosynthesis study, MLO view, of a 55-year-old female at average risk with dense breast tissue, interpreted as negative (BIRADS2). (b) The corresponding MIP image of the abbreviated breast MRI study is positive for significant enhancement which corresponded to a small invasive breast cancer. MIP, maximum intensity projections; MLO, mediolateral oblique.

Figure 2.

Flow chart of the EA1141 study. AB-MR, abbreviated breast MRI. DBT, digital breast tomosynthesis. PRO, patient reported outcomes; QOL, quality of life.