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Update in Women's Health
- Carolyn Crandall, MD, MS; and
- Janet P. Pregler, MD
- From the Iris Cantor-UCLA Women's Health Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California.
2005–2006 Series: Update Sessions from ACP's 2005 Annual Session
This Update in Women's Health reviews the past year's research publications that have the most relevance to the practice of internal medicine. We have included a summary of new guideline recommendations for the prevention of heart disease in women. Our selection process was guided by advice from our colleagues in general internal medicine, geriatrics, obstetrics and gynecology, cardiology, and oncology.
Breast Cancer
Magnetic Resonance Imaging Was More Sensitive than Ultrasound, Mammography, or Clinical Breast Examination for Detecting Breast Cancer in BRCA1 and BRCA2 Mutation Carriers
Women with mutations of the BRCA1 and BRCA2 genes have a lifetime breast cancer risk of 50% to 85%. Routine mammography detects approximately 50% of tumors in women with the mutation versus 75% of tumors in women who do not have the mutation (1). Decreased sensitivity of mammography in BRCA1 and BRCA2 mutation carriers is the result of several factors. BRCA1 and BRCA2 mutation carriers are more likely to develop breast cancer at younger ages, when dense breast tissue makes tumors more difficult to detect. In addition, breast cancer in patients with BRCA1 is less likely to be associated with microcalcifications and more likely to have round margins, making it more difficult to identify by mammography.
This study compared the sensitivity and specificity of mammography, magnetic resonance imaging (MRI), ultrasonography, and clinical breast examination in 263 Canadian women with BRCA1 or BRCA2 mutations. The women, who ranged in age from 25 to 65 years, underwent 1 to 3 annual examinations with 3 modalities: mammography, MRI, and ultrasonography. Clinical breast examination was also performed on the day of screening and at 6-month intervals.
Of 22 detected tumors (16 invasive and 6 ductal carcinoma in situ), 17 (77%) were detected by MRI, 8 (36%) by mammography, 7 (33%) by ultrasonography, and 2 (9%) by clinical breast examination. After initial screening with MRI, 26% of the study participants were recalled for further diagnostic …
