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Joo Y, Kim MJ, Yoon JH, Rho M, Park VY. Second breast cancer following negative breast MRI: Analysis by interval from surgery and risk factors. PLoS One 2024; 19:e0306828. [PMID: 39146263 PMCID: PMC11326552 DOI: 10.1371/journal.pone.0306828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVES This study aims to compare outcomes following a negative surveillance MRI study by surgery-MRI interval and investigate factors associated with second breast cancers in women with a personal history of breast cancer (PHBC). METHODS This retrospective study included 1552 consecutive women (mean age, 53 years) with a PHBC and a negative prevalence surveillance breast MRI result between August 2014 and December 2016. The incidence and characteristics of second breast cancers were reviewed and compared according to surgery-MRI interval (< 3 years vs ≥ 3 years). Logistic regression analysis was used to investigate associations with clinical-pathologic characteristics. RESULTS Twenty-five second breast cancers occurred after negative MRI. The incidence of second breast cancers or local-regional recurrence did not significantly differ by surgery-MRI interval. The median intervals between MRI to second breast cancer detection showed no significant difference between the two groups (surgery-MRI interval <3 years vs. ≥ 3 years). Two node-positive second breast cancers were detected in the group with <3 years interval. BRCA mutation status, receipt of breast-conserving surgery, and adjuvant chemotherapy (all p < .05) were significant factors associated with the development of second breast cancers. CONCLUSION Outcomes following a negative surveillance MRI did not differ by surgery-MRI interval. BRCA mutation status, receipt of breast-conserving surgery and adjuvant chemotherapy were independently associated with the risk of developing second breast cancers after negative surveillance MRI.
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Affiliation(s)
- Yohan Joo
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Miribi Rho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kang D, Kim S, Han J, Kim Y, Cho J, Lee JE, Ko ES. Measuring patient-reported distress from breast magnetic resonance imaging: Development and validation of the MRI-related distress scale (MRI-DS). Cancer Med 2024; 13:e70089. [PMID: 39126264 PMCID: PMC11316135 DOI: 10.1002/cam4.70089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/08/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE Although breast magnetic resonance imaging (MRI) is a valuable screening tool, breast MRI testing burden was associated with cancer worry and quality of life. We aimed to develop and validate the MRI-related distress scale (MRI-DS) to assess comprehensive distress specifically related to breast MRI. METHODS We enrolled women aged above 18 years, diagnosed breast cancer, had MRI examination at least one time, and who could speak and read Korean in phase I and enrolled women aged above 18 years, visited outpatient clinic of breast general surgery, had undergone MRI examination at least once, and could speak and read Korean in phase II. We excluded patients who had any physical or psychiatric conditions in both phases. We recruited from a tertiary university-based hospital in South Korea between April and August 2023. RESULTS All 18 items had acceptable levels of item correlation (≥0.30) in the explanatory factor analysis with a four-factor solution. The fit indices for the four-factor solution model were good. The discriminant validity of the MRI-DS had a moderate correlation with general anxiety or quality of life. In the known-group analysis, those who reported MRI as the most burden breast examination had higher total scores. CONCLUSION The validity of the MRI-DS has been confirmed as a scale for measuring the specific distress caused by breast MRI. The MRI-DS is recommended to health professional to communicate with patients with MRI. CLINICAL IMPLICATIONS It can be used to assess the distress associated with MRI screening in breast cancer patients. Physician could use MRI-DS to discuss the reasons for distress caused by breast MRI screening and to address specific sources of discomfort associated with it.
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Affiliation(s)
- Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical CenterSeoulSouth Korea
- Department of Clinical Research Design and Evaluation, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
| | - Sooyeon Kim
- Center for Clinical Epidemiology, Samsung Medical CenterSeoulSouth Korea
- Department of Clinical Research Design and Evaluation, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
| | - Jiyoon Han
- Center for Clinical Epidemiology, Samsung Medical CenterSeoulSouth Korea
- Department of Clinical Research Design and Evaluation, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
| | - Youngha Kim
- Center for Clinical Epidemiology, Samsung Medical CenterSeoulSouth Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical CenterSeoulSouth Korea
- Department of Clinical Research Design and Evaluation, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
- Cancer Education Center, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
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Patel BK, Carnahan MB, Northfelt D, Anderson K, Mazza GL, Pizzitola VJ, Giurescu ME, Lorans R, Eversman WG, Sharpe RE, Harper LK, Apsey H, Cronin P, Kling J, Ernst B, Palmieri J, Fraker J, Mina L, Batalini F, Pockaj B. Prospective Study of Supplemental Screening With Contrast-Enhanced Mammography in Women With Elevated Risk of Breast Cancer: Results of the Prevalence Round. J Clin Oncol 2024:JCO2202819. [PMID: 39058970 DOI: 10.1200/jco.22.02819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) have shown similar diagnostic performance in detection of breast cancer. Limited CEM data are available for high-risk breast cancer screening. The purpose of the study was to prospectively investigate the efficacy of supplemental screening CEM in elevated risk patients. MATERIALS AND METHODS A prospective, single-institution, institutional review board-approved observational study was conducted in asymptomatic elevated risk women age 35 years or older who had a negative conventional two-dimensional digital breast tomosynthesis screening mammography (MG) and no additional supplemental screening within the prior 12 months. RESULTS Four hundred sixty women were enrolled from February 2019 to April 2021. The median age was 56.8 (range, 35.0-79.2) years; 408 of 460 (88.7%) were mammographically dense. Biopsy revealed benign changes in 22 women (22/37, 59%), high-risk lesions in four women (4/37, 11%), and breast cancer in 11 women (11/37, 30%). Fourteen cancers (10 invasive, tumor size range 4-15 mm, median 9 mm) were diagnosed in 11 women. The overall supplemental cancer detection rate was 23.9 per 1,000 patients, 95% CI (12.0 to 42.4). All cancers were grade 1 or 2, ER+ ERBB2-, and node negative. CEM imaging screening offered high specificity (0.875 [95% CI, 0.844 to 0.906]), high NPV (0.998 [95% CI, 0.993 to 1.000), moderate PPV1 (0.164 [95% CI, 0.076 to 0.253), moderate PPV3 (0.275 [95% CI, 0.137 to 0.413]), and high sensitivity (0.917 [95% CI, 0.760 to 1.000]). At least 1 year of imaging follow-up was available on all patients, and one interval cancer was detected on breast MRI 4 months after negative screening CEM. CONCLUSION A pilot trial demonstrates a supplemental cancer detection rate of 23.9 per 1,000 in women at an elevated risk for breast cancer. Larger, multi-institutional, multiyear CEM trials in patients at elevated risk are needed for validation.
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Affiliation(s)
- Bhavika K Patel
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Donald Northfelt
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Karen Anderson
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Roxanne Lorans
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Laura K Harper
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Heidi Apsey
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Patricia Cronin
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Juliana Kling
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Brenda Ernst
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Jessica Fraker
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Lida Mina
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Felipe Batalini
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Barbara Pockaj
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
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Elliott MJ, Shen S, Lam DL, Brown T, Lawson MB, Iyengar NM, Cescon DW. Enhancing Early-Stage Breast Cancer Survivorship: Evidence-Based Strategies, Surveillance Testing, and Imaging Guidelines. Am Soc Clin Oncol Educ Book 2024; 44:e432564. [PMID: 38815189 DOI: 10.1200/edbk_432564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Addressing the challenges of survivorship necessitates a comprehensive, patient-centered approach, focusing on mitigating risk through lifestyle modification, identifying distant recurrence, and optimization of breast imaging. This article will discuss the current and emerging clinical strategies for the survivorship period, advocating a multidisciplinary and comprehensive approach. In this manner, early-stage breast cancer survivors are empowered to navigate their journey with enhanced knowledge, facilitating a transition to life beyond cancer.
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Affiliation(s)
- Mitchell J Elliott
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sherry Shen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Diana L Lam
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Thelma Brown
- University of Alabama at Birmingham, Birmingham, AL
| | - Marissa B Lawson
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | | | - David W Cescon
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Lawson MB, Herschorn SD, Sprague BL, Buist DSM, Lee SJ, Newell MS, Lourenco AP, Lee JM. Imaging Surveillance Options for Individuals With a Personal History of Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:854-868. [PMID: 35544374 PMCID: PMC9691521 DOI: 10.2214/ajr.22.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Annual surveillance mammography is recommended for breast cancer survivors on the basis of observational studies and meta-analyses showing reduced breast cancer mortality and improved quality of life. However, breast cancer survivors are at higher risk of subsequent breast cancer and have a fourfold increased risk of interval breast cancers compared with individuals without a personal history of breast cancer. Supplemental surveillance modalities offer increased cancer detection compared with mammography alone, but utilization is variable, and benefits must be balanced with possible harms of false-positive findings. In this review, we describe the current state of mammographic surveillance, summarize evidence for supplemental surveillance in breast cancer survivors, and explore a risk-based approach to selecting surveillance imaging strategies. Further research identifying predictors associated with increased risk of interval second breast cancers and development of validated risk prediction tools may help physicians and patients weigh the benefits and harms of surveillance breast imaging and decide on a personalized approach to surveillance for improved breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, University of Vermont Cancer Center, Burlington, VT
| | - Brian L Sprague
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Su-Ju Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
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Bahl M. Screening MRI in Women at Intermediate Breast Cancer Risk: An Update of the Recent Literature. JOURNAL OF BREAST IMAGING 2022; 4:231-240. [PMID: 35783682 PMCID: PMC9233194 DOI: 10.1093/jbi/wbac021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Guidelines issued by the American Cancer Society (ACS) in 2007 recommend neither for nor against screening MRI in women at intermediate breast cancer risk (15%–20%), including those with dense breast tissue, a history of lobular neoplasia or atypical ductal hyperplasia (ADH), or a prior breast cancer, because of scarce supporting evidence about the utility of MRI in these specific patient populations. However, since the issuance of the ACS guidelines in 2007, multiple investigations have found that women at intermediate risk may be suitable candidates for screening MRI, given the high detection rates of early-stage cancers and acceptable false-positive rates. For women with dense breast tissue, the Dense Tissue and Early Breast Neoplasm Screening trial reported that the incremental cancer detection rate (CDR) by MRI exceeded 16 cancers per 1000 examinations but decreased in the second round of screening; this decrease in CDR, however, occurred alongside a marked decrease in the false-positive rate. For women with lobular neoplasia or ADH, single-institution retrospective analyses have shown CDRs mostly ranging from 11 to 16 cancers per 1000 MRI examinations, with women with lobular carcinoma in situ benefitting more than women with atypical lobular hyperplasia or ADH. For patients with a prior breast cancer, the cancer yield by MRI varies widely but mostly ranges from 8 to 20 cancers per 1000 examinations, with certain subpopulations more likely to benefit, such as those with dense breasts. This article reviews and summarizes more recent studies on MRI screening of intermediate-risk women.
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Affiliation(s)
- Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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Chang JM. MRI Screening Interval in Women with a History of Breast Cancer. Radiology 2021; 300:312-313. [PMID: 34032518 DOI: 10.1148/radiol.2021210836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jung Min Chang
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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