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Update in Radiology
Screening in patients with increased risk of breast cancer (part 1): Pros and cons of MRI screening
Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 1). Pros y contras del cribado con resonancia magnética
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S. Alonso Roca
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salonsor1@yahoo.es

Corresponding author.
, A.B. Delgado Laguna, J. Arantzeta Lexarreta, B. Cajal Campo, S. Santamaría Jareño
Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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S. Alonso Roca, A.B. Delgado Laguna, J. Arantzeta Lexarreta, B. Cajal Campo, A. López Ruiz
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Received 28 March 2019. Accepted 30 January 2020
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Table 1A. Patients at HR included in the recommendation for screening with MRI.
Table 1B. ACR update.8,a
Table 2. Guidelines for action in women with a personal history of BC (Houssami et al., 2018).12,a
Table 3. Conclusions of the meta-analysis by Li et al.57,a
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Abstract

Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.

Keywords:
Cancer screening
Magnetic resonance imaging
Mammography
Breast tumours
Risk factors
Genetic predisposition to disease
Sensitivity and specificity
Resumen

En mujeres con alto riesgo de padecer cáncer de mama, la detección precoz tiene un importante papel. Debido a la alta incidencia de cáncer mamario y a edades más tempranas que en la población general, se recomienda que el cribado comience en edad más joven, y existe amplia evidencia de que la resonancia magnética es la herramienta diagnóstica más sensible: las principales guías americanas y europeas coinciden en la recomendación de realizar resonancia magnética anual (con mamografía anual suplementaria) como modalidad óptima de cribado. No obstante, no hay un total consenso actual entre las guías sobre algunos subgrupos de pacientes a incluir en la recomendación de cribado con resonancia magnética.

El objetivo de esta primera parte de nuestro trabajo es, mediante una revisión de la bibliografía, explicar y valorar las ventajas que este tipo de cribado con resonancia magnética proporciona respecto al cribado solo con mamografía, como son: mayor detección de cánceres de menor tamaño y con menor afectación ganglionar asociada y una reducción de los cánceres de intervalo, lo que puede tener repercusión en supervivencia y mortalidad, con efectos comparables a otras medidas de prevención. Pero, a su vez, también queremos reflejar los inconvenientes que el cribado con resonancia magnética conlleva, y que dificultan su aplicabilidad.

Palabras clave:
Detección precoz de cáncer
Resonancia magnética
Mamografía
Neoplasias mamarias
Factores de riesgo
Predisposición genética a la enfermedad
Sensibilidad y especificidad

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