Comparison of breast magnetic resonance imaging, mammography, and clinical breast exam for surveillance of women at high risk for hereditary breast cancer

4733 Purpose: Recommended surveillance for women at high risk for breast cancer, including BRCA1 and BRCA2 mutation carriers, includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in these women has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with mammography, and physical examination in women at high risk for hereditary breast cancer. Patients and Methods: A total of 178 women, aged 22-74 years, of which 51 had proven BRCA1 or BRCA2 mutations and the remainder had a strong family histories of breast or ovarian cancer. These women underwent clinical breast exam, and if this was normal, mammography and MRI were done on the same day. A biopsy was performed when either mammography or breast MRI investigations were judged to be suspicious for malignancy. Results: Three women required a biopsy based on abnormal results. The only invasive breast cancer occurred in a mutation carrier with a history of right-sided breast cancer and was only detected by MRI. This breast cancer was in the left breast, measured l.2 cm in diameter and all nodes were negative. Conclusion: Breast MRI only detected one invasive breast cancer in this series of 178 women at high risk for hereditary breast cancer. As this study contains preliminary data, conclusions regarding the use of MRI as a screening tool in women at high-risk for breast cancer cannot be drawn until appropriate follow-up is performed with these women.