Rationale and Objectives
The purpose of this study was to examine whether patients with premenopausal breast cancer history only can benefit from screening breast magnetic resonance imaging (MRI) by comparing them to patients with both a personal and a family history of breast cancer.
Materials and Methods
With Institutional Review Board approval and waiver of informed consent, a retrospective review was conducted to determine patients previously diagnosed with premenopausal breast cancer undergoing screening MRI. From December 2003 to October 31, 2014, a total of 4436 screening MRI examinations were performed; 381 examinations were performed in 131 patients with a personal history (PH) of premenopausal breast cancer. This cohort was evaluated further and revealed 146 examinations in 52 patients with PH only, and 235 examinations in 79 patients with personal history and family history (PHFH). Fisher’s exact test was used to compare the distribution between the groups.
Results
Total number of MRI examinations performed per patient ranged from 1 to 10, with an average of 2.9 in the PHFH group and 2.8 in the PH only group. Patient age at time of original diagnosis was significantly different between the groups ( P = 0.0391). There were 74 (19.4%) suspicious MRI findings: 27 in the PH only group and 47 in the PHFH group. Fifty-two had needle biopsy tissue sampling performed; three additional lesions were sampled at excision. Malignancy was detected in 27.3%: 53.3% in the PHFH group and 46.7% in the PH only group ( P = 0.7963). There was no significant difference when the pathology between the PH only group and the PHFH group was compared ( P = 0.5692). Of those diagnosed with cancer, average time between diagnoses was 6.9 years for the PHFH group and 7.1 for the PH only group (range 2–16).
Conclusions
Patients with a PH only are at a similar risk level as those with additional family history for the development of a subsequent breast cancer and therefore benefit from screening breast MRI, as a similar rate of cancer detection was found in both groups.
Introduction
Women with a personal history (PH) of breast cancer are at risk for the development of local recurrence, a second ipsilateral cancer, or a contralateral cancer . Recurrence rates have been reported to be at less than 10% at 10 years and the lifetime risk for these women depends on the age at diagnosis . The early detection of breast cancer recurrence has been shown to significantly improve long-term survival . The risk that remains for women with a PH of breast cancer warrants vigilant monitoring.
Breast magnetic resonance imaging (MRI) has been proven to have high sensitivity for the detection of breast cancers, reportedly as high as 94–100% . This high sensitivity of MRI for breast cancer detection has led to the increase in the use of the technology for screening. It has been reported that MRI has high sensitivity, specificity, and accuracy in differentiating scar from recurrence , which has provided value for use of the technology in patients with PH of breast cancer. Despite the benefit breast MRI can afford to the population of women with a PH of breast cancer, the American Cancer Society , the Society of Breast Imaging, and the American College of Radiology believe that there is not enough evidence to recommend for or against yearly MRI screening for those with intermediate risk, which includes those with a PH of breast cancer. Currently, annual screening MRI is recommended for women who are at high risk for breast cancer based on certain factors, including a greater than 20% calculated lifetime risk or positive genetic testing for a BRCA1 or a BRCA2 mutation.
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Materials and Methods
Patient Cohort
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Breast MRI Technique
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Breast MRI Image Interpretation
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Data Collection and Analysis
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Results
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Table 1
Patient Demographics
Total ( n = 131) PH Only Group ( n = 52) PHFH Group ( n = 79)P Value Average age at original cancer diagnosis 40.7 39.4 41.5 0.0391 Range 19–49 19–48 28–49 Prior radiation (%) 98 (74.8) 34 (65.4) 64 (81.0) 0.1385 Heterogeneously dense/extremely dense breast tissue (%) 97 (74.1) 37 (71.2) 60 (76.0) 0.7811 Number of MRI examinations per patient 2.9 2.77 2.96 Range 1–10 1–10 1–8
MRI, magnetic resonance imaging; PH, personal history; PHFH, personal history and family history.
Table 2
Histology of Prior Cancer
Histology Total PH Only Group PHFH Group DCIS 31 13 18P = 0.5075 IDC 87 31 56 ILC 7 4 3 IMC 2 2 0 Unknown 4 2 2 Total 131 52 79
DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; IMC, invasive mammary carcinoma; PH, personal history; PHFH, personal history and family history.
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Table 3
Biopsied Findings
Total PH Only Group PHFH Group MRI examinations 381 146 235 Number of MRI findings 74 27 47 Number of biopsies \* 52 19 33 Malignant 15 7 8 Benign 35 13 22 Atypical 5 2 3
MRI, magnetic resonance imaging; PH, personal history; PHFH, personal history and family history.
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Table 4
Malignant Pathology
Malignant Pathology Total PH Only Group PHFH Group Invasive ductal carcinoma 10 5 5 Invasive lobular carcinoma 1 1 0 DCIS 4 1 3 Total 15 7 8
DCIS, ductal carcinoma in situ; PH, personal history; PHFH, personal history and family history.
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Discussion
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Acknowledgment
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