Rationale and Objectives
In 2007, the American Cancer Society (ACS) recommended that women at elevated risk of breast cancer be screened with breast magnetic resonance imaging (MRI) as an adjunct to mammography. This study estimates the proportion of women presenting for screening mammography who are at elevated lifetime risk of breast cancer as determined by the Gail model. This study provides preliminary information for a proposed follow-up study, including the proportion of women who completed the recommended MRI at the same clinic that had conducted the risk assessment.
Materials and Methods
This study is an observational prospective cohort of 64,659 women presenting for mammographic screening at a single high-volume clinic. If a woman reported a first-degree maternal relative with breast cancer and had at least 20% lifetime risk on the Gail model, the radiologist’s report included a recommendation that the primary care physician refer the woman for breast MRI screening. Records were examined to determine if women completed the recommended MRI at the clinic within one year of the initial risk assessment.
Results
Of 64,659 women, 1,246 (1.9%) had a lifetime risk of breast cancer of 20% or greater, and 436 (0.7 %) had a lifetime risk of breast cancer 25% or greater. Of the women at elevated risk, 173 (13.9%) completed the recommended breast MRI screening at the clinic within a year.
Conclusion
The effectiveness of matching screening intensity to risk on cancer detection, biopsy rate, and cost should be evaluated by studying multiple clinics and multiple risk assessment tools.
Breast cancer is the second leading cause of cancer deaths for women in the United States . Despite recent controversy over screening regimens , several meta-analyses of randomized controlled trials demonstrate that mammography reduces mortality . Presumably, screening reduces mortality by finding potentially fatal cancers early enough so that treatment is successful. In 2003, a total of 51,479,694 women (68% of the 73,858,958 women in the United States) reported using mammography in the past 2 years .
The sensitivity of digital mammography is about 70% . Contrast enhanced magnetic resonance imaging (MRI) of the breast has a sensitivity of 88.1% . In 2007, the American Cancer Society (ACS) issued guidelines suggesting that women at elevated risk for breast cancer be screened with breast MRI as an adjunct to mammography . The ACS recommended screening with breast MRI and mammography in women who 1) have a BRCA1/2 mutation or are the untested first-degree relative of a BRCA1/2 mutation carrier; 2) have a lifetime risk of breast cancer of 20%–25% or greater, as defined by a risk model that takes into account extended family history; 3) are at elevated risk because of an inherited cancer syndrome; or 4) have had previous radiation therapy to the chest between 10 and 30 years of age.
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Materials and methods
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Statistical Analysis
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Results
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Table 1
Study Population Cross-classified by Lifetime Risk for Breast Cancer and Reported Maternal Family History
Gail Lifetime Risk Family History No Family History ∗ <20% 9,612 (14.9) 53,871 (83.3) 20%–25% 745 (1.2) – >25% 431 (0.7) –
Data in parenthesis are the percent of the total ( n = 64,659).
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Table 2
Breast MRI Screening Recommendations and Completion by Age Group
Age Overall MRI Recommended MRI Completed Yes No Yes No <40 1,772 (2.7) 97 (0.1) 1,675 (2.6) 17 (1.4) 80 (6.4) 40–49 21,407 (33.1) 498 (0.8) 20,909 (32.4) 73 (5.9) 425 (34.1) ≥50 41,480 (64.2) 651 (1.0) 40,829 (63.2) 83 (6.7) 568 (46.6) Total 64,659 (100.0) 1,246 (1.9) 63,413 (98.1) 173 (13.9) 1,073 (86.1)
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Discussion
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Limitations of the Study and of the Clinical Protocol for Risk Assessment
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Future Studies
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Conclusion
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Acknowledgment
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