Clinical Question

Does breast cancer screening with magnetic resonance imaging (MRI), alone or with mammography, improve diagnostic yield?

Bottom Line

Screening with MRI is not for everyone. Women who undergo breast cancer screening with MRI are much more likely to be referred for biopsy— that will ultimately be negative—than if they have screening mammography alone. This is even true of women with a personal history of breast cancer. The benefit of possible early detection of breast cancer with MRI has to be carefully weighed against unnecessary additional diagnostic maneuvers. (Level of Evidence = 2b)

Synopsis

This study analyzed data collected in six Breast Cancer Surveillance Consortium registries throughout the United States, comprising 812,164 women undergoing a total of 2,048,994 digital mammographies, breast MRIs, or both between the years of 2003 and 2013. Most women had no history of breast cancer; those who did have a personal history of breast cancer received their diagnosis at least six months prior. In women without a personal history of breast cancer, age-adjusted biopsy rates were much higher following MRI than mammography alone: 8.47% vs. 1.49%. Ductal carcinoma in situ and invasive biopsy yield were significantly higher following mammography in women with a history of breast cancer. High-risk benign lesions (lobular carcinoma and atypical hyperplasia) were more commonly identified by MRI, regardless of personal history of breast cancer.

Study design: Cohort (prospective)

Funding source: Government

Setting: Outpatient (any)

Reference: Buist DS, Abraham L, Lee CI, et al.; Breast Cancer Surveillance Consortium. Breast biopsy intensity and findings following breast cancer screening in women with and without a personal history of breast cancer. JAMA Intern Med. 2018;178(4):458–468.