Breakthrough in breast cancer diagnosis

In recent decades, contrast-enhanced magnetic resonance imaging has gained recognition as a valuable screening tool for women at high risk of developing breast cancer. From 2000 to 2015, multiple studies confirmed the clear superiority of MRI over mammography (and in some studies over ultrasound) in women with a family history of breast cancer.

• 10 studies

• 15 publications

• >6000 women

• almost 19,000 rounds of screening

showed that MRI sensitivity ranges from 71% to 100%, which is significantly higher than mammography and ultrasound.

In 2006–2007, based on these data, the first recommendations for the use of MRI to screen high-risk women were issued, and the American Cancer Society (ACS) guidelines recommended MRI for women with a risk of developing breast cancer greater than 20–25%.

Since then, many other organizations have issued similar recommendations. For example, the European Society of Breast Imaging (EUSOBI) and the multidisciplinary European Society of Breast Cancer Specialists (EUSOMA).

Interestingly, MRI was recommended based on comparative studies of test accuracy rather than according to evidence-based medicine (EBM) guidelines. One reason was ethical: Because MRI is highly accurate, it would be unethical to deprive women of the test to control the study group. This is why randomized controlled trials (RCTs) to evaluate the effectiveness of MRI for high-risk women were not proposed until 2019.

In 2019, the results of the first RCT were published, which confirmed the effectiveness of MRI for screening women at high risk of developing breast cancer.

Research in numbers:

• 1355 women

• 675 in the MRI group

• 680 in the mammography group.

• 4.3 rounds of screening (average) per woman

• 40 cases of breast cancer were detected by MRI

• 15 cases of breast cancer were detected by mammography

Women who underwent MRI had significantly smaller tumors and were less likely to have lymph node metastases, reducing the need for adjuvant chemotherapy and improving prognosis.

These results highlight that MRI can detect breast cancer at earlier stages, reducing the incidence of advanced cancer and improving the quality of life of patients. This is especially important for carriers of BRCA mutations, since their cancer develops faster and is more often triple negative.

An example of the successful use of MRI in clinical practice was also shown by the German Consortium for Hereditary Breast and Ovarian Cancer.

Research in numbers:

• 4573 women at high risk of developing breast cancer

• 14,142 rounds of MRI screening over 10 years

• 221 cases of breast cancer

• 86% of which were stage 0 or I, confirming the high sensitivity of MRI in this program

In summary, MRI for screening women at high risk of developing breast cancer has proven to be effective and valuable, despite implementation challenges and the lack of initial RCTs. It is important to continue to research and implement advanced diagnostic methods to improve the health and quality of life of patients.