Breast screening with magnetic resonance imaging in high-risk women

Introduction

The Cancer Reform Strategy [1] and NICE guidelines [2] highlighted the need to identify women at increased genetic risk of breast cancer. Following this, a magnetic resonance imaging (MRI) screening service was established in Newcastle.

Methods

Women were identified from the Regional Genetic Centre database, following assessment by a consultant geneticist as high risk according to the NICE guidelines [2]. Screening comprised annual MRI ± mammography, depending on their age, following the standards set by the NHSBSP [3]. All investigations were double-read by NHSBSP-compliant radiologists.

Results

A total of 142 women underwent 311 screening episodes between January 2008 and June 2012. There were 28 recalls (9%) for second-look ultrasound in 24 women. Thirteen lesions had a core biopsy, from which six (1.9%) malignancies were identified of varying histological type, size and grade. Seven lesions were benign. No ultrasound abnormality was found in the remaining 15 lesions. No interval cancers have developed.

Conclusion

In our unit, high-risk MRI screening is effective and efficient, with a cancer detection rate of 0.2 per 1,000 women screened and no false negative screens to date, with an acceptable recall rate for second-look ultrasound (within the standard set under the NHSBSP guidelines). This has been possible due to the close liaison between the departments of Genetics and Breast Screening.