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Combining MRI and mammography for women at high risk for breast cancer.
Combining contrast-enhanced MRI screening with mammography may make sense for women with a known or likely genetic predisposition to breast cancer, according to the findings of a systematic literature review.
Researchers from Canada reviewed 11 relevant, prospective, nonrandomized studies. They calculated negative likelihood ratios and the probability of a BI-RADS–suspicious lesion (given negative test findings and assuming a 2% pretest probability of disease) to be 0.70 (95% CI, 0.59–0.82) and 1.4% (95% CI, 1.2%–1.6%) for mammography alone and 0.14 (95% CI, 0.05–0.42) and 0.3% (95% CI, 0.1%–0.8%) for MRI plus mammography. A BI-RADS score of 4 or higher was used to define positive.
Given that women who possess autosomal-dominant mutations in BRCA1 or BRCA2 genes are at up to 85% greater lifetime risk for breast cancer than other women, the added sensitivity of the dual screening strategy may be well worth the added expense.