Breast MRI Effective in Identifying Early-Stage Breast Cancer

To detect interval cancers in women who have a personal history of breast cancer, breast MRI is an effective tool for supplemental screening.

With findings that add to the growing body of knowledge about the efficacy and utility of breast MRI in detecting cancer, a team of researchers from Seoul National University Hospital determined the scan could do a better job identifying early recurrent breast cancer than mammography in women who have a personal history of the disease. They also found MRI may be more effective in preventing advanced-stage interval cancers.

The team, led by Ga Ram Kim, M.D., from the Seoul National University Hospital, published their findings in Radiology on June 8.

“We aimed to evaluate the performance measures of screening breast MRI in women with a personal history of breast cancer across multiple rounds and to identify sub-groups who might be more at risk for interval cancer,” the team said. “Our results could provide valuable information to establish risk-based surveillance strategies for women with a [personal history.]”

While that body of evidence is mounting about breast MRI’s superior detection capabilities, there is still a lack of research into how well it performs in picking up interval cancers in this particular group of women. Kim’s team set out to assess performance.

For their study, they assessed 6,603 MRI scans conducted on 2,809 Asian women who were, on average, age 47. Based on their analysis, the cancer detection rate was 8.3 cancers per 1,000 screening exams. They also identified a higher interval cancer rate in women with personal histories when compared with women of average risk – 1.5 cancers per 1,000 screenings versus 0-to-0.83 cancers per 1,000 exams.

Overall, they said, breast MRI sensitivity and specificity were 85 percent and 88.3 percent.

Alongside these results, Kim’s team determined interval cancers are associated with three factors:

• Moderate or marked background parenchymal enhancement (BPE): OR 10.8
• First-degree breast cancer family history: OR 5.4
• Estrogen receptor, progesterone receptor-negative primary cancer: OR 3.6

In addition, the team discovered a three-year median interval between initial cancer surgery and the detection of the second breast cancer. It also took an average of 6.6 months for an interval cancer to be detected after a previous negative MRI, they said. These results indicate that aggressive primary breast cancer, due to rapid growth, can interfere with the identification of second cancers at subsequent screening.

“Tailored surveillance guidelines accounting for the characteristics of primary breast cancer and BPE on MRI scans might be beneficial for women with a personal history of breast cancer,” they said.

It is important to note, though, the team said, that mammography still outperformed breast MRI in detecting interval cancers in women with a personal breast cancer history. Mammography’s detection rate was 3.5-to-3.6 interval cancers per 1,000 screening exams.

Still, even though additional research is still warranted, the team emphasized that because their findings with breast MRI were largely early-stage cancers, using the tool for supplemental screening is preferable to mammography.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter here.