Outcomes of Density-Targeted Supplemental Breast Magnetic Resonance Imaging Screening by Breast Cancer Risk: Long-Term Health and Economic Considerations

作者：Anna N.A. Tosteson, Natasha K. Stout, Yu-Ru Su, Nicolien T. van Ravesteyn, Kathryn P. Lowry, Linn Abraham, Oguzhan Alagoz, Roberta M diFlorio-Alexander, Harry J. de Koning, John Hampton, Louise Henderson, Jeanne S. Mandelblatt, Tracy Onega, Clyde B. Schechter, Brian L. Sprague, Sarah Stein, Amy Trentham-Dietz, Diana L. Miglioretti, K. Kerlikowske, Christoph I. Lee · 发表于：Annals of Internal Medicine · 年份：2026 · DOI：10.7326/annals-25-00792 · 被引用次数：1 · 研究领域：MRI in cancer diagnosis、Breast Cancer Treatment Studies、Global Cancer Incidence and Screening

BACKGROUND: Federally mandated breast density notifications motivate consideration of supplemental breast magnetic resonance imaging (MRI). OBJECTIVE: To evaluate supplemental breast MRI strategies. DESIGN: Simulation of women at average to 4 times higher-than-average relative risk (RR) for breast cancer incidence undergoing screening digital breast tomosynthesis (DBT) with or without supplemental MRI. DATA SOURCES: Breast Cancer Surveillance Consortium and literature. TARGET POPULATION: Women aged 40 years or older. TIME HORIZON: Lifetime. PERSPECTIVE: U.S. federal payer. INTERVENTION: Screening with DBT with or without breast density-targeted MRI by starting age (40, 45, or 50 years) and interval (annual or biennial). OUTCOME MEASURES: Breast cancer deaths averted, false-positive biopsy recommendations, harm-benefit ratios, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: Across all starting ages and intervals, DBT averted 7.4 to 10.5 breast cancer deaths per 1000 average-risk women screened and 23.2 to 33.6 per 1000 women with 4 times higher-than-average risk. Across all RR levels, DBT with supplemental MRI for women with extremely dense breasts (DBT+MRId) averted 0.1 to 0.8 additional breast cancer deaths and resulted in 22 to 186 additional false-positive biopsy recommendations. False-positive biopsies per breast cancer death averted for biennial DBT+MRId for women with 2 times higher-than-average risk were similar to those associated wit...