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In Reply: We agree with Dr Helvie that the fact that most of the patients in our study received previous mammography but not MRI could artificially increase the difference in sensitivity between MRI and mammography observed in the first round of screening (85% vs 38%). However, since the performance of the data analysis on which our article was based, most of the patients in the published cohort have had 1 or 2 additional rounds of screening. There have been 7 additional cancers identified in this cohort (1 on screen 2, 3 on screen 4, and 3 on screen 5); all 7 were detected by screening MRI but only 2 were detected by screening mammography. Therefore, of the total of 16 incident cancers, 13 (81%) were detected by MRI and 5 (31%) by mammography. These findings are almost identical with those in a recent update of the Dutch National Study.¹

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Ellen Warner, MD
ellen.warner@sw.ca
Department of Medicine

Roberta Jong, MD
Department of Medical Imaging

Donald Plewes, PhD; Martin Yaffe, PhD
Imaging Research and Department of Medical Biophysics

Steven Narod, MD
Center for Research in Women’s Health
Sunnybrook and Women’s College Health Sciences Centre
Toronto, Ontario

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