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Vol. 62. Issue 5.
Pages 417-433 (September - October 2020)
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Vol. 62. Issue 5.
Pages 417-433 (September - October 2020)
Update in Radiology
DOI: 10.1016/j.rxeng.2020.04.006
Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies
Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 2). ¿Dónde estamos? Controversias actuales 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, A. López Ruiz
Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
Related content
Radiologia. 2020;62:252-6510.1016/j.rxeng.2020.01.009
S. Alonso Roca, A.B. Delgado Laguna, J. Arantzeta Lexarreta, B. Cajal Campo, S. Santamaría Jareño
Received 28 March 2019. Accepted 14 April 2020
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Tables (4)
Table 1. Genes associated with a high risk of breast cancer (carriers of mutations in those genes, included in the high-risk screening protocol).36
Table 2. Summary table with recommendations for screening in high-risk cases from the major American and European associations (we have added other specific representative recommendations from countries such as Spain, the United Kingdom and Canada).
Table 3. Characteristics of breast cancers in subgroups of carriers of a BRCA1 or BRCA2 gene mutation.
Table 4. High-risk follow-up programme with magnetic resonance imaging. German Consortium of Hereditary Breast and Ovarian Cancer (GC-HBOC), Germany.35
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Abstract

For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening.

In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery. The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.

Keywords:
Early detection of cancer
Magnetic resonance imaging
Mammography
Breast neoplasms
Risk factors
Genetic predisposition 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 de mama en ellas, y a edades más tempranas que en la población general, el cribado comienza antes, 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 suplemento mamográfico anual) como modalidad óptima de cribado.

Además de la ausencia de consenso actual sobre qué pacientes deben incluirse en la recomendación de cribado con resonancia magnética (ampliamente tratada en la introducción de la parte 1 de esta actualización (Radiología. DOI: 10.1016/j.rx.2020.01.007)), existen otros aspectos no coincidentes en diferentes guías, o no concretados, o susceptibles de modificación según la evidencia de tantos años de experiencia, que hemos denominado «controversias», como son: la edad de comienzo del cribado, la posible conveniencia de emplear diferente estrategia en distintos subgrupos, la realización alterna vs. síncrona de la resonancia y la mamografía, la edad de finalización de las dos técnicas o la forma de realizar el seguimiento tras cirugía de reducción de riesgo. El objetivo de la segunda parte de nuestro trabajo es realizar, revisando la literatura científica, una actualización sobre esas principales «controversias» en el cribado con resonancia magnética en alto riesgo. Y finalmente, basándose en ello, proponer un posible modelo de protocolo de cribado óptimo y actualizado.

Palabras clave:
Detección precoz de cáncer
Resonancia magnética
Mamografía
Neoplasias mamarias
Factores de riesgo
Enfermedad de predisposición genética
Sensibilidad y especificidad

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