FORCE’s eXamining the Relevance of Articles for Young Survivors (XRAYS) program is a reliable resource for breast cancer research-related news and information. XRAYS reviews new breast cancer research, provides plain-language summaries, and rates how the media covered the topic. XRAYS is funded by the CDC.
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MRI and mammograms are used together to detect breast cancer in high-risk women who test positive for a BRCA or other gene mutation that increases the risk for breast cancer. For women with a family history of cancer breast cancer but no known genetic mutation, increased screening is recommended. But what method is best? A recent clinical trial in the Netherlands compared MRI and mammography for this population. (8/15/19)
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whether MRI or mammograms are better at detecting cancers in women with a family history of breast cancer but no known genetic mutation.
Prior studies show that MRI plus mammography is more effective than mammography alone for detecting breast cancer in high-risk women. The FaMRisC study is the first randomized controlled trial to compare breast MRI and mammograms for breast cancer detection in women with a family history of breast cancer.
If you have a family history of breast cancer and you do not have a mutation in a gene associated with breast cancer (e.g. BRCA1, BRCA2, TP53, ATM, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, or STK11 genes), you may still benefit from breast cancer screening by MRI. MRI appears to detect breast cancers at earlier stages, at smaller sizes, and more frequently before node involvement occurs. You may have more false positive results with MRI. The expectation is that this early detection may improve outcomes, as expected from related studies, although the data from this study is still incomplete.
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Fifteen percent of all women with breast cancer have a family history of the disease but have no known mutation associated with increased breast cancer risk. Several trials that looked at adding MRI to mammography as a screening method showed that breast cancer cases were detected earlier than with mammography alone. However, these were not randomized trials and MRI was done at the same time as mammography. Additionally, these trials did not determine how breast density affected MRI results.
Current NCCN guidelines in the United States recommend annual mammography and clinical breast exam with MRI for women 30 or older who have a lifetime risk of breast cancer of 20% or more. However, in other countries these recommendations vary. In the Netherlands and U.K., MRI is only recommended for women with BRCA1 or BRCA2 mutations. For this study, researchers want to know how MRI compares to mammography at detecting breast cancer for women with familial breast cancer.
whether MRI or mammography are better at detecting cancer in women with a family history of breast cancer but without a known genetic mutation.
This trial enrolled 1,355 women from 12 outpatient breast cancer clinics or family cancer clinics from 7 academic medical centers in the Netherlands between Jan 1, 2011 and Dec 31 2017. Participants were 30-55 years of age with a lifetime risk of breast cancer of 20% or higher based on family history. Women with a known inherited mutation in BRCA1, BRCA2 or TP53 were excluded because MRI surveillance is already recommended for them. Women with previously diagnosed invasive breast cancer were also excluded. One woman in the MRI group was diagnosed with an invasive breast cancer after randomization and before initial MRI screening and was excluded. After randomization, the total number of participants was 1,354: 674 in the MRI group and 680 in the mammography group.
Women who did not consent to randomization of screening methods were registered, screened by their chosen method and their results were included in analysis of screening method among groups with different breast densities. There were 13 women in the MRI registration group and 218 in the mammography registration group. Combining the randomized and registry groups, there were 206 women with category A breast density (fatty, not dense), 549 women with category B breast density (scattered density), 562 women with category C breast density (heterogeneously dense), and 239 women with category D breast density (extremely dense).
Participants were randomized to one of two groups:
The average number of screening rounds was 4.3 screenings per person. Participants were followed for an average of 5.2 years after joining the study.
A total of 55 breast cancers were detected (32 invasive cancer cases and 23 ductal carcinoma in situ (DCIS) cases). None of the breast cancers were bilateral and none had metastasized.
A clear limitation of MRI as a screening method is the frequency of false positive results. These results require further testing and biopsies to rule out an invasive cancer diagnosis. On the other hand, the rate of detecting earlier, node negative cancers suggest that MRI screening may lead to improved outcomes in terms of mortality. The researchers note that they intend to follow up with mortality data in the future.
Another potential problem is that MRI uses a gadolinium tracer, which carries a small chance of very small amounts being retained in brain tissue. This is not known to cause harmful effects.
MRI was better at detecting cancers in most breast tissue (groups A-C) than mammography. Contrary to the researchers’ expectation, MRI was not significantly different from mammography at detecting breast cancers in the group of women with the most dense breast tissue. Similar numbers of cancers were detected by both methods, suggesting that neither method is better or worse than the other. The numbers of breast cancers in each breast density group were small, which may have limited the ability to observe small differences. Additionally, compared to mammography, MRI produced far more false positives among women with extremely dense breasts. This may limit its usefulness among this population.
The researchers concluded that MRI detected breast cancers at earlier stages than mammography and at all but the most extreme breast densities. One drawback is that MRI screening led to more false positives than mammography. Overall, MRI may improve detection for high-risk women who do not have known genetic mutations.
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The U.S. Centers for Disease Control and Prevention (CDC) runs the National Breast and Cervical Cancer Early Detection Program. The program provides breast and cervical cancer screening and diagnostic services for low-income, uninsured, and underserved women in all 50 states, the District of Columbia, six U.S. territories, and to 13 Native American/Alaska Native tribal organizations
Patient Services Incorporated, in partnership with Right Action for Women offers a financial assistance program to help young women who are at high risk for breast cancer gain access to Magnetic Resonance Imaging (MRI) screening.
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FORCE XRAYS category: Screening
Saadatmand S, Geuzinge A, Rutgers JT, et al., "MRI versus mammography for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial." The Lancet. August 1, 2019; 20(8):1136-1147.