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New research indicates that breast MRIs performed in BRCA mutation carriers yield a high rate of false-positive results, yet this appears to have little impact on a woman's choice to undergo or not undergo prophylactic mastectomy. "New research indicates that breast MRIs performed in BRCA mutation carriers yield a high rate of false-positive results, yet this appears to have little impact on a woman's choice to undergo or not undergo prophylactic mastectomy.

"The final decision to actually undergo prophylactic mastectomy appeared to be determined more frequently by a woman's prior preference than a positive scan," lead author Dr. Nicoline Hoogerbrugge, from Nijmegen Medical Centre in the Netherlands, said in a statement.

As reported in the Annals of Oncology for April, Dr. Hoogerbrugge and colleagues assessed prophylactic mastectomy rates in 196 BRCA mutation carriers who were followed for a median of two years with annual mammography and MRI. The patients' preference for prophylactic mastectomy was recorded at first surveillance after their BRCA status was revealed.

Forty-one per cent of women had at least one positive MRI or mammography reading, the report indicates. Cancer was identified in 17 patients: 11 at surveillance, four at intended prophylactic mastectomy, and two had interval malignancies.

In combination, mammography and MRI were 71 per cent sensitive and 90 per cent specific in detecting breast cancer. MRI had a false-positive rate of 83 per cent.

Among women with a prior preference for mastectomy, the prophylactic mastectomy rates in women with and without false-positive imaging results were 89 and 66 per cent, respectively (p = 0.06). The corresponding rates among women who preferred surveillance were 15 and 11 per cent.

"It is important to give BRCA mutation carriers correct risk information for the decision process, because preventive surgery is irreversible," Dr. Hoogerbrugge emphasized. "This study has made me realize that for women at high hereditary risk of breast cancer, accurate detection techniques are of the utmost importance, even at the cost of a high false positive rate because most women can cope with a false positive MRI result."