Emily Fox Conant MD, Abstract Co-Author: Nothing to Disclose

Mitchell Dennis Schnall MD, Abstract Co-Author: Nothing to Disclose

Susan Pae Weinstein MD, Abstract Co-Author: Nothing to Disclose

Mark Alan Rosen MD, PhD, Presenter: Nothing to Disclose

Steven Gilbert Lee MD, Abstract Co-Author: Nothing to Disclose

Susan Greenstein Orel MD, Abstract Co-Author: Nothing to Disclose

Peter Wahl, Abstract Co-Author: Nothing to Disclose

Phyllis Gimotty PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate digital mammography (DM), ultrasound in combination with film-screen mammography (US) and MRI, as single modalities and in combination, for screening of patients considered to be at high risk for developing breast cancer.

Thus far, 151 patients have been enrolled in an IRB approved screening program. Entry criteria requires the patients to: either have a history of a prior contralateral breast cancer treated without systemic chemotherapy(Contralateral n=84), or a Claus or Gail lifetime risk of > 25%, or prior biopsy proven ADH, ALH or LCIS(High Risk n=67). Contralateral patients were imaged bilaterally with all modalities. High risk patients with breasts considered heterogeneously dense or greater underwent imaging with all modalities. Patients with less than heterogeneously dense breasts were randomized to receive a single study (DM, US or MRI) or a combination of modalities. Imaging studies were interpreted independently (blinded) and then in a consensus format.

Forty-one biopsies were recommended in 32 of the 151 patients for a biopsy rate of 21%, by patient. Four cancers have been detected: 3 in high-risk patients (all heterogeneously dense) and 1 in a contralateral patient (scattered density). The cancer detection rate was 2.6%. Three of the 4 cancers were seen only by MRI. The fourth cancer in the contralateral patient was seen by both DM and MRI. The 41 biopsies were recommended under the following guidance modalities: 27/MRI, 9/US, 4/FS and 1/DM. Short-term follow-up has been recommended in 34 patients (22.5%).

While the cancer detection rate was significant (2.6%), there was a very high biopsy and short-term follow-up rate(21% and 22.5%, respectively). Hopefully, further accrual to the study and evaluation of the study population may help guide recommendations for multimodality breast cancer screening in the future.

Conant, E, Schnall, M, Weinstein, S, Rosen, M, Lee, S, Orel, S, Wahl, P, Gimotty, P, et al, , Multimodality Screening for Breast Cancer in a High Risk Population.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4414248.html