Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density

Author:

Kerlikowske Karla12ORCID,Zhu Weiwei3,Su Yu-Ru3,Sprague Brian L4,Stout Natasha K5,Onega Tracy6,O’Meara Ellen S3,Henderson Louise M7,Tosteson Anna N A8,Wernli Karen3,Miglioretti Diana L39

Affiliation:

1. Departments of Medicine and Epidemiology and Biostatistics, University of California , San Francisco, CA, USA

2. General Internal Medicine Section, Department of Veterans Affairs, University of California , San Francisco, CA, USA

3. Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington , Seattle, WA, USA

4. Departments of Surgery and Radiology, University of Vermont , Burlington, VT, USA

5. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, MA, USA

6. Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute , Salt Lake City, UT, USA

7. Department of Radiology, University of North Carolina , Chapel Hill, NC, USA

8. The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth , Lebanon, NH, USA

9. Department of Public Health Sciences, University of California , Davis, CA, USA

Abstract

Abstract Background Examining screening outcomes by breast density for breast magnetic resonance imaging (MRI) with or without mammography could inform discussions about supplemental MRI in women with dense breasts. Methods We evaluated 52 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score–matched to 65 810 screening mammograms. Rates per 1000 examinations of interval, advanced, and screen-detected early stage invasive cancers and false-positive recall and biopsy recommendation were estimated by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy. Results Screen-detected early stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9; difference = 6.4, 95% confidence interval [CI] = 2.5 to 10.3) and dense (7.5 vs 3.5; difference = 4.0, 95% CI = 1.4 to 6.7) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5; difference = 11.7, 95% CI = 4.6 to 18.8). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5; difference = 0.4, 95% CI = -0.8 to 1.6) or dense breasts (1.5 vs 1.4; difference = 0.0, 95% CI = -1.2 to 1.3), nor were advanced cancer rates. Interval rates were not statistically different for MRI vs MRI plus mammography for nondense (2.6 vs 0.8; difference = 1.8 (95% CI = -2.0 to 5.5) or dense breasts (0.6 vs 1.5; difference = -0.9, 95% CI = -2.5 to 0.7), nor were advanced cancer rates. False-positive recall and biopsy recommendation rates were statistically higher for MRI groups than mammography alone. Conclusion MRI screening with or without mammography increased rates of screen-detected early stage cancer and false-positives for women with dense breasts without a concomitant decrease in advanced or interval cancers.

Funder

Patient-Centered Outcomes Research Institute

National Cancer Institute

Agency for Health Research and Quality

University of Vermont Cancer Center

Lake Champlain Cancer Research Organization

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Beyond the AJR: Breast MRI Finds More Breast Cancers Than Mammography;American Journal of Roentgenology;2024-01-03

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