Contrast-enhanced MR Imaging as a Breast Cancer Screening in Women at Intermediate Risk

A Multicenter Randomised Trial of Contrast-enhanced MR Imaging as a Breast Cancer Screening Tool Alternative to Mammography and Ultrasonography in Women at Intermediate Risk. Feasibility, and Short Term Results.

A multicenter randomized controlled trial to evaluate the performance of MRI, in terms of sensitivity, specificity, and predictive value, in the screening of women at intermediate risk of breast cancer.

Two surveillance programs will be compared. Women will be randomly assigned with a 1:1 ratio to:

1. Yearly two-view mammography (Mx) and breast ultrasonography (US) or
2. Yearly MRI.

Women, who, due to an increased risk of invasive breast cancer, are offered a specific surveillance program, as a supplement to the standard screening activities which in Italy are based on mammography every two years starting at age 50.Women will be randomly assigned to Yearly two-view mammography (Mx) and breast ultrasonography (US) or to Yearly MRI.

Inclusion Criteria:

• Women aged 40-59 years with
• cumulative risk at 10 years of at least 5%, or a lifetime cumulative breast cancer risk ranging between 15% and 30% (equivalent to a relative risk of 2-6 as compared to a low risk woman of the same age). The lifetime cumulative risk of breast cancer will be computed using the IBIS Breast Cancer Risk Evaluation Tool (http://www.ems-trials.org/riskevaluator/); or mammographic density involving more than 75% of the breast area, based on the most recent mammogram. The evaluation of the composition of the mammary gland will be performed using the BI-RADS classification. Women with mammography in class 4 (i.e., >75% of glandular component) will be eligible for randomization.
• Written Informed consent

Exclusion Criteria:

• Signs or symptoms of breast cancer at enrolment;
• Previous diagnosis of ductal carcinoma in situ or invasive breast cancer;
• BRCA or p53 mutation carrier status;
• General contraindications to MRI (e.g. cardiac pacemaker, metal implants or history of severe allergic reaction after administration of contrast agent;
• Contraindications to any intravenous administration of contrast agent;
• Ongoing or planned pregnancy (for the duration of the study);
• Hormonal enhancement of ovarian function for assisted reproduction in the previous 3 years
• Presence of breast implants;
• Previous diagnosis of cancer at any site;
• Life-threatening diseases;
• Mental disability precluding informed consent to participate