Researchers from Memorial Sloan Kettering Cancer Center (MSK), in collaboration with an international research team and the ECOG-ACRIN Cancer Research Group, have found that abbreviated breast magnetic resonance imaging (MRI) detected more cancers than digital breast tomosynthesis (3-D mammography) in average-risk women with dense breast tissue.
Bottom Line: The study compared an abbreviated breast MRI (a ten-minute MRI exam) to 3-D mammography in women with dense breasts. Historically, the ability to detect breast cancer in women with dense breast tissue through mammography has been limited because mammography is less sensitive to the breast tissue. With 3-D mammography, there is some improvement; it finds roughly 20 percent more cancers than regular mammography.
Method: Women eligible to participate in the study were between the ages of 40 and 75, had dense breasts on their prior mammogram, and did not currently have breast cancer or any clinical symptoms, such as BRCA status or a family history of breast cancer. In total, 1,444 trial participants were enrolled; all were screened with both 3-D mammography and abbreviated breast MRI within 24 hours. Participants were screened twice in the study, first as a baseline and again after one year, and are being followed for three additional years.
Enrollment for this trial took place from December 2016 through November 2017 at 48 centers across the United States and in Germany.
Findings: In the first year of the study, 23 women were diagnosed with breast cancer. The abbreviated MRI detected 22 out of the 23 women with breast cancer, while the 3-D mammogram detected only nine out of the 23 women. Abbreviated MRI detected all of the cancers found on 3-D mammography except for one early-stage cancer. Additionally, abbreviated MRI found an additional ten invasive breast cancers, including three high-grade cancers, which were not detected on 3-D mammography at the time of the scan.
About Breast and Abbreviated Breast MRI: Breast MRI is the most sensitive imaging method to detect cancer, outperforming mammography, digital breast tomosynthesis, and ultrasound. Dynamic contrast-enhanced MRI has been recommended, according to the American Cancer Society’s guidelines, for women with a high lifetime risk of breast cancer (greater than 15 to 20 percent).
Despite encouraging results among women at an average risk, conventional breast MRI is currently not recommended as a screening method, mostly due to its higher relative costs, the longer time it takes, and the lack of widespread availability compared to conventional imaging.
Abbreviated breast MRI includes only the most useful series of images, thereby shortening the time of the exam. Although abbreviated breast MRI has been studied in small, single-institution retrospective studies, this trial was the first prospective multicenter trial of abbreviated breast MRI and included 48 centers from the United States and Germany.
Journal: “Comparison of abbreviated breast MRI versus digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening” appears in the February 25, 2020, issue of the Journal of the American Medical Association.
Author: Christopher Comstock, MD, FACR, Attending Radiologist at MSK, was the study’s lead author.
Expert Commentary: “When screening women at average risk with dense breasts, we found that abbreviated breast MRI detected significantly more — almost two and a half times as many — breast cancers as 3-D mammography. We also found that the abbreviated breast MRI was well tolerated by women, with very few side effects,” said Christopher E. Comstock, MD, of MSK and the study’s lead author.
“We are really encouraged by these new study results,” said Elizabeth Morris, MD, FACR, FSBI, FISMRM, Chief of the Breast Radiology Service at MSK. “At MSK, we are exploring more advanced techniques to detect cancers earlier to lead to better treatment. The landscape of breast radiology is ever-changing, and here at MSK, we are leading much of this research.”
“MSK continues to be a leader in breast diagnostics as well as treatment and prevention,” said Larry Norton, MD, Senior Vice President in the Office of the President and Medical Director of the Evelyn Lauder Breast Center at MSK. “This study shows that techniques such as MRI might help us find even smaller tumors than are found by conventional techniques, but this is just the beginning of an exciting new era on breast cancer diagnostics. At MSK, we are dedicated to providing our patients with the most useful tests tailored to their particular case and at the same time conducting the research necessary to make improved diagnostics available everywhere.
MSK and Breast Diagnostics: At MSK, we strive to optimize patient outcomes with the latest, most accurate, and cost-effective imaging techniques. Our breast radiologists collaborate with multidisciplinary experts to deliver individualized diagnostic and treatment plans for each patient.
Bottom Line for Patients: At MSK, the screening recommendations for women of average risk are that women between the ages of 25 and 40 have an annual clinical breast examination, women 40 and older should have an annual mammogram in addition to an annual clinical breast examination, and ultrasound may be recommended for women with dense breast tissue. All women should consider performing a monthly breast self-exam beginning at age 20 and become familiar with their breasts so they are better able to notice changes.
Funding: The ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) designed and conducted the study, and is supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: CA189828, CA180790, CA180791, CA180795, CA180828, CA180847, CA180868, 495 CA189819, CA180836, CA189860, and CA189956. For the conduct of this study, ECOG-ACRIN received additional funding from Bracco Diagnostics Inc.