Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer

Importance There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC). Objective To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC. Design, Setting, and Participants Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013. Exposures A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days). Main Outcomes and Measures Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC. Results We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk. Conclusions and Relevance Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.

[1]  C. Lehman,et al.  Performance Benchmarks for Screening Breast MR Imaging in Community Practice. , 2017, Radiology.

[2]  C. Lehman,et al.  National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium. , 2017, Radiology.

[3]  Jane M Lange,et al.  Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy , 2017, JAMA oncology.

[4]  Gary H Lyman,et al.  American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  Amy Cantor,et al.  Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation , 2016, Annals of Internal Medicine.

[6]  Christoph I. Lee,et al.  Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status , 2016, Cancer.

[7]  Per Skaane,et al.  Breast cancer screening with digital breast tomosynthesis , 2016, Breast Cancer.

[8]  Constance D Lehman,et al.  Digital Breast Tomosynthesis and the Challenges of Implementing an Emerging Breast Cancer Screening Technology Into Clinical Practice. , 2016, Journal of the American College of Radiology : JACR.

[9]  Gillian D Sanders,et al.  Benefits and Harms of Breast Cancer Screening: A Systematic Review. , 2015, JAMA.

[10]  C. Vachon,et al.  Breast Density and Benign Breast Disease: Risk Assessment to Identify Women at High Risk of Breast Cancer. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  C. Lehman,et al.  Five-year risk of interval-invasive second breast cancer. , 2015, Journal of the National Cancer Institute.

[12]  I Sechopoulos,et al.  Review of radiation dose estimates in digital breast tomosynthesis relative to those in two-view full-field digital mammography. , 2015, Breast.

[13]  L. Hardesty Issues to consider before implementing digital breast tomosynthesis into a breast imaging practice. , 2015, AJR. American journal of roentgenology.

[14]  Yit Yoong Lim,et al.  The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme--a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. , 2015, Health technology assessment.

[15]  Emily F Conant,et al.  Breast cancer screening using tomosynthesis in combination with digital mammography. , 2014, JAMA.

[16]  Andriy I Bandos,et al.  Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images. , 2014, Radiology.

[17]  D. Miglioretti,et al.  Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. , 2014, American journal of surgery.

[18]  S. Fletcher,et al.  Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011. , 2014, JAMA internal medicine.

[19]  Karla Kerlikowske,et al.  Patterns of breast magnetic resonance imaging use in community practice. , 2014, JAMA internal medicine.

[20]  Karla Kerlikowske,et al.  Benign breast disease, mammographic breast density, and the risk of breast cancer. , 2013, Journal of the National Cancer Institute.

[21]  M. Marmot Sorting through the arguments on breast screening. , 2013, JAMA.

[22]  D. Miglioretti,et al.  Risk Factors for Second Screen-Detected or Interval Breast Cancers in Women with a Personal History of Breast Cancer Participating in Mammography Screening , 2013, Cancer Epidemiology, Biomarkers & Prevention.

[23]  A. Bleyer,et al.  Effect of three decades of screening mammography on breast-cancer incidence. , 2012, The New England journal of medicine.

[24]  Karla Kerlikowske,et al.  Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. , 2011, JAMA.

[25]  Karla Kerlikowske,et al.  Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer , 2010, Breast Cancer Research and Treatment.

[26]  Laura Esserman,et al.  Rethinking screening for breast cancer and prostate cancer. , 2009, JAMA.

[27]  S. Hoover,et al.  High-risk benign breast lesions: current strategies in management. , 2007, Cancer control : journal of the Moffitt Cancer Center.

[28]  M. Yaffe,et al.  American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography , 2007, CA: a cancer journal for clinicians.

[29]  Marcelo Coca-Perraillon Local and Global Optimal Propensity Score Matching , 2007 .

[30]  K. Kerlikowske,et al.  Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. , 1997, AJR. American journal of roentgenology.