Breast Cancer Screening (PDQ®)–Health Professional Version - National Cancer Institute

Breast Cancer Screening (PDQ®)–Health Professional Version - National Cancer Institute

Breast Cancer Screening (PDQ®)–Health Professional Version

Other Imaging Modalities: Ultrasound, Magnetic Resonance Imaging (MRI), Thermography

Ultrasound

Ultrasound is used for the diagnostic evaluation of palpable or mammographically identified masses, rather than serving as a primary screening modality. A review of the literature and expert opinion by the European Group for Breast Cancer Screening concluded that “there is little evidence to support the use of ultrasound in population breast cancer screening at any age.”[1] The Japan Strategic Anti-cancer Randomized Trial (J-START) is a screening trial that randomly assigned women aged 40 to 49 years to either mammography and ultrasound screening (intervention group) or mammography screening alone (control group). The initial results of this trial indicated that the addition of screening ultrasound to mammography substantially increases breast cancer detection rates, but the impact on breast cancer mortality has not yet been evaluated.[2]

Breast MRI

Breast MRI is used in women for diagnostic evaluation, including evaluating the integrity of silicone breast implants, assessing palpable masses after surgery or radiation therapy, detecting mammographically and sonographically occult breast cancer in patients with axillary nodal metastasis, and preoperative planning for some patients with known breast cancer. There is no ionizing radiation exposure with this procedure. MRI has been promoted as a screening test for breast cancer among women at elevated risk of breast cancer based on BRCA1/2 mutation carriers, a strong family history of breast cancer, or several genetic syndromes, such as Li-Fraumeni syndrome or Cowden disease.[3-5] Breast MRI is more sensitive but less specific than screening mammography [6,7] and is up to 35 times as expensive.[8-12]

Thermography

Using infrared imaging techniques, thermography of the breast identifies temperature changes in the skin as a possible indicator of an underlying tumor, displaying these changes in color patterns. Thermographic devices have been approved by the U.S. Food and Drug Administration under the 510(k) process, but no randomized trials have compared thermography to other screening modalities. Small cohort studies do not suggest any additional benefit for the use of thermography as an adjunct modality.[13,14]

References

1. Teh W, Wilson AR: The role of ultrasound in breast cancer screening. A consensus statement by the European Group for Breast Cancer Screening. Eur J Cancer 34 (4): 449-50, 1998. [PUBMED Abstract]
2. Ohuchi N, Suzuki A, Sobue T, et al.: Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial. Lancet 387 (10016): 341-348, 2016. [PUBMED Abstract]
3. Warner E, Plewes DB, Hill KA, et al.: Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 292 (11): 1317-25, 2004. [PUBMED Abstract]
4. Kriege M, Brekelmans CT, Boetes C, et al.: Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351 (5): 427-37, 2004. [PUBMED Abstract]
5. Warner E, Hill K, Causer P, et al.: Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol 29 (13): 1664-9, 2011. [PUBMED Abstract]
6. Lord SJ, Lei W, Craft P, et al.: A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer 43 (13): 1905-17, 2007. [PUBMED Abstract]
7. Lehman CD, Gatsonis C, Kuhl CK, et al.: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356 (13): 1295-303, 2007. [PUBMED Abstract]
8. Pataky R, Armstrong L, Chia S, et al.: Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation carriers. BMC Cancer 13: 339, 2013. [PUBMED Abstract]
9. Saadatmand S, Tilanus-Linthorst MM, Rutgers EJ, et al.: Cost-effectiveness of screening women with familial risk for breast cancer with magnetic resonance imaging. J Natl Cancer Inst 105 (17): 1314-21, 2013. [PUBMED Abstract]
10. Ahern CH, Shih YC, Dong W, et al.: Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk. Br J Cancer 111 (8): 1542-51, 2014. [PUBMED Abstract]
11. Pistolese CA, Ciarrapico AM, della Gatta F, et al.: Inappropriateness of breast imaging: cost analysis. Radiol Med 118 (6): 984-94, 2013. [PUBMED Abstract]
12. Cott Chubiz JE, Lee JM, Gilmore ME, et al.: Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers. Cancer 119 (6): 1266-76, 2013. [PUBMED Abstract]
13. Wishart GC, Campisi M, Boswell M, et al.: The accuracy of digital infrared imaging for breast cancer detection in women undergoing breast biopsy. Eur J Surg Oncol 36 (6): 535-40, 2010. [PUBMED Abstract]
14. Arora N, Martins D, Ruggerio D, et al.: Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg 196 (4): 523-6, 2008. [PUBMED Abstract]