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To the Editor: The study by Dr Warner and colleagues¹ comparing magnetic resonance imaging (MRI), mammography, ultrasound, and clinical breast examination in screening BRCA1 and BRCA2 carriers for breast cancer has several potential limitations that could affect their conclusions.

First, the study compared prevalent cancer screening by MRI with incident cancer screening by mammography. This may bias against mammography since prevalent screening generally detects more cancer than incident screening. The sensitivity of MRI in prevalent screen 1 was better than its performance in subsequent incident screens, with sensitivity decreasing from 85% to 71% and 50% on annual screens 1, 2, and 3, respectively. This same pattern was observed by Kriege et al² with MRI sensitivity decreasing from 79% at screen 1 to 62% at screen 2.

Second, different interpretive threshold behaviors for mammography vs MRI may have biased the reported sensitivities. The positive predictive value for mammography was much . . . [Full Text of this Article]

Mark Helvie, MD
mahelvie@umich.edu
Division of Breast Imaging
University of Michigan Health System
Ann Arbor

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