The effectiveness of adding MRI to mammography when screening high risk women

Abstract

Recent evidence indicates that MRI used together with mammography in women at high risk of breast cancer is a more efficient screening method than mammography alone. This study synthesised seven eminent studies to examine this increasingly popular view by answering the following research question: ‘Does adding MRI to mammography improve the effectiveness of cancer detection when screening high risk women?’ The study considered women with more than a 20% lifetime risk of developing breast cancer. It compared the outcomes of screening using mammography combined with MRI with those using only mammography. All literature in English from the year 2000 on, was searched through dozens of relative databases using the University of Malta’s HyDi system. The search retrieved 271 articles, 17 of which were highly relevant. Using the Prisma guidelines, this selection was refined further to include five cohort studies and two systematic reviews. The CASP appraisal program was used to critique the studies. This dissertation shows that using MRI as an adjunct to routine screening presents a more effective approach, that yields more cancers at an earlier stage of disease, than mammography alone. MRI was also found to be particularly effective at detecting cancers in woman at higher lifetime risk. In view of these findings, this study argues that MRI should be considered as an effective adjunct to local screening procedures. In line with this, it also recommends an effective and ethical method of identifying high risk women together with the development of policy guidelines that specifically address high risk populations.