van Winkel Suzanne L, Samperna Riccardo, Loehrer Elizabeth A, Drukker Caroline A, Sessink Kelly, Karssemeijer Nico, Mann Ritse M
Medical Imaging Department, Radboudumc: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Clinical Genetics, Erasmus MC: Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur Radiol. 2025 Jun 12. doi: 10.1007/s00330-025-11718-7.
This study evaluates breast cancer (BC) detection in women with ≥ 20% lifetime risk who discontinued annual breast MRI screening surveillance.
This retrospective single screening cohort (2003-2019) study included 3308 women who received at least one breast MRI. After verifying with the Netherlands Comprehensive Cancer Organization (IKNL), a sub-population of women who developed BC after discontinuation was identified. Screening indications, BC incidence rates, tumor characteristics, and reasons for MRI screening discontinuation were compared between women who continued and those who discontinued MRI screening using descriptive and inferential methods.
Among 3308 participants, 2647 discontinued MRI screening. After discontinuation, 58/2647 (2.2%) developed BC (43 invasive, 13 DCIS, 2 NA). Initial screening indications included: personal (26/58, 44.8%) or family history (17/58, 29.3%) of BC, BRCA1 (3/58, 5.2%), BRCA2 (1/58, 1.7%), chest irradiation (1/58, 1.7%), other mutations (2/58, 3.4%) and other (8/58, 13.8%). Of these, 27 continued mammography screening, detecting 23 BC-cases. Discontinuation was mainly physician-driven. Invasive tumor size after cessation of MRI screening tended to be larger compared to tumors detected while participating in MRI screening (median difference: 7.0 mm, 95% CI: 4.0-10.0, p < 0.001). Mean age at diagnosis was 58. Median time from last MRI to diagnosis was 5.9 years.
Women with a personal or family history of BC commonly discontinued MRI screening, often influenced by referring physicians. However, after cessation of MRI screening, a substantial number of these women are still diagnosed with BC, challenging current MRI screening regulations. Although a last negative MRI appears to reduce the subsequent decade's likelihood of BC, post-MRI discontinuation detected tumors are prognostically worse, highlighting the need for more personalized, extended screening.
Question Current regulations and duration of MRI screening do not suit the entire increased-risk population. Findings Early discontinuation disproportionately affects women with a personal or family history. Cancers detected after cessation of MRI screening seem larger and more often invasive. Clinical relevance Because certain women with a personal or family risk indication could benefit from a longer duration of MRI screening, extended, personalized screening beyond current guidelines is suggested.
本研究评估终身风险≥20%且停止年度乳腺MRI筛查监测的女性中的乳腺癌（BC）检出情况。
这项回顾性单筛查队列（2003 - 2019年）研究纳入了3308名接受过至少一次乳腺MRI检查的女性。经荷兰综合癌症组织（IKNL）核实后，确定了停止筛查后发生BC的女性亚组。采用描述性和推断性方法，比较了继续进行MRI筛查和停止MRI筛查的女性之间的筛查指征、BC发病率、肿瘤特征以及停止MRI筛查的原因。
在3308名参与者中，2647人停止了MRI筛查。停止筛查后，2647人中的58人（2.2%）发生了BC（43例浸润性癌，13例导管原位癌，2例未明确）。初始筛查指征包括：个人BC病史（26/58，44.8%）或家族BC病史（17/58，29.3%）、BRCA1（3/58，5.2%）、BRCA2（1/58，1.7%）、胸部放疗（1/58，1.7%）、其他突变（2/58，3.4%）以及其他（8/58，13.8%）。其中，27人继续进行乳腺钼靶筛查，检测出23例BC病例。筛查的停止主要由医生主导。与在参与MRI筛查期间检测到的肿瘤相比，停止MRI筛查后浸润性肿瘤大小往往更大（中位差异：7.0 mm，95%CI：4.0 - 10.0，p < 0.001）。诊断时的平均年龄为58岁。从最后一次MRI检查到诊断的中位时间为5.9年。
有个人或家族BC病史的女性通常会停止MRI筛查，这往往受到转诊医生的影响。然而，在停止MRI筛查后，这些女性中仍有相当数量被诊断出患有BC，这对当前的MRI筛查规定提出了挑战。尽管最后一次MRI检查结果为阴性似乎会降低随后十年患BC的可能性，但MRI检查停止后检测到的肿瘤预后更差，这凸显了进行更个性化、延长筛查的必要性。
问题 当前的MRI筛查规定和持续时间并不适用于整个高风险人群。发现 早期停止筛查对有个人或家族病史的女性影响尤为严重。MRI筛查停止后检测到的癌症似乎更大且更常为浸润性。临床意义 由于某些有个人或家族风险指征的女性可能从更长时间的MRI筛查中获益，建议在当前指南之外进行延长的、个性化的筛查。
