Oncology ·
MRI screening detects more early breast cancers but not fewer advanced cancers
A Breast Cancer Surveillance Consortium cohort study examined 172,865 screening examinations in 105,532 women aged 40 to 74 years. MRI was associated with higher early-stage cancer detection and substantially more false-positive biopsy recommendations than mammography, but advanced cancer rates did not differ significantly between modalities by risk group.
- MRI detected more stage I cancers than mammography.
- MRI had substantially higher false-positive biopsy recommendation rates.
- Advanced cancer rates did not differ significantly by screening modality.
- Repeat MRI was associated with lower advanced cancer rates.
This cohort study included women aged 40 to 74 years screened at Breast Cancer Surveillance Consortium facilities from 2005 through 2021. Researchers compared MRI screening (with or without mammography within 12 months) with mammography alone, grouping examinations by estimated risk of advanced breast cancer. Outcomes included advanced invasive cancer, screen-detected stage I cancer, and false-positive biopsy recommendations per 1,000 examinations.
Among mammography examinations, intermediate-to-high-risk women had higher rates than low-to-average-risk women of advanced cancer (0.6 vs 0.3), stage I cancer (2.8 vs 1.8), and false-positive biopsy recommendations (18.1 vs 14.7). MRI was associated with higher stage I detection than mammography in both risk groups: 10.3 vs 2.8 per 1,000 examinations in the intermediate-to-high-risk group and 11.4 vs 1.8 in the low-to-average-risk group. False-positive biopsy recommendation rates were also higher with MRI, at about 93 to 94 per 1,000, versus 15 to 18 with mammography.
Advanced cancer rates did not differ significantly between MRI and mammography within risk groups. The observational findings do not establish that MRI reduces advanced cancer; lower rates were observed among women undergoing subsequent versus first MRIs. The study supports discussion of MRI screening in elevated-risk women, while highlighting the higher false-positive burden and uncertainty about effects on advanced disease.
In practice
For women aged 40 to 74 years undergoing breast screening, this cohort found MRI was associated with substantially more stage I cancer detection than mammography, but also many more false-positive biopsy recommendations. Advanced cancer rates were not significantly lower with MRI within either risk group. These observational findings can inform discussions about screening trade-offs for women with elevated advanced-cancer risk, but do not show that MRI prevents advanced disease or establish which women benefit; the lower rate with repeat versus first MRI is also not proof of a causal effect.
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JAMA Network Open: Magnetic Resonance Imaging and Mammography Outcomes by Advanced Breast Cancer Risk ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.