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To the Editor: Dr Plevritis and colleagues¹ used a computer model to evaluate the cost-effectiveness of using breast magnetic resonance imaging (MRI) to screen carriers of BRCA1/2 mutations. Based on their assumptions, the authors concluded that the most cost-effective strategy is annual breast MRI for BRCA1/2 carriers from age 35 to 54 years.

One of the assumptions in the model was that all tumors larger than 5 mm are detectable by MRI. However, this is not supported by current data from the largest studies that used breast MRI screening (Table).^2-5 The impact of performance characteristics of MRI screening (including mean detectable tumor size, false-positive rate, and resultant benign biopsies) must be considered in accurately understanding its cost-effectiveness in screening BRCA1/2 mutation carriers.

Table appears in full text version. Table. Characteristics of Breast Magnetic Resonance Imaging in Screening High-Risk Women Found in Previous Studies

Financial Disclosures: None reported.

Pavel Crystal, MD
pavel.crystal@utoronto.ca
Department of Medical Imaging
Mount Sinai Hospital
Toronto, Ontario

1. Plevritis SK, Kurian AW, Sigal BM, et al. Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA. 2006;295:2374-2384. FREE FULL TEXT 2. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351:427-437. FREE FULL TEXT 3. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365:1769-1778. FULL TEXT | ISI | PUBMED 4. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004;292:1317-1325. FREE FULL TEXT 5. Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 2005;23:8469-8476. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296:2681-2682.

RELATED LETTER

Cost-effectiveness of Breast Magnetic Resonance Imaging to Screen BRCA1/2 Mutation Carriers—Reply
Sylvia K. Plevritis, Debra M. Ikeda, and Alan M. Garber
JAMA. 2006;296(22):2682.
EXTRACT | FULL TEXT