Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 1). Pros y contras del cribado con resonancia magnética / Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening

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

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

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.

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 «controversies¼, 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 «controversies¼ in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.

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.

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.