http://repub.eur.nl/res/aut/12149/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/27708/ 2010-01-01T00:00:00Z In order to assess the characteristics of malignant breast lesions those were not detected during screening by MR imaging. In the Dutch MRI screening study (MRISC), a non-randomized prospective multicenter study, women with high familial risk or a genetic predisposition for breast cancer were screened once a year by mammography and MRI and every 6 months with a clinical breast examination (CBE). The false-negative MR examinations were subject of this study and were retrospectively reviewed by two experienced radiologists. From November 1999 until March 2006, 2,157 women were eligible for study analyses. Ninety-seven malignant breast tumors were detected, including 19 DCIS (20%). In 22 patients with a malignant lesion, the MRI was assessed as BI-RADS 1 or 2. One patient was excluded because the examinations were not available for review. Forty-three percent (9/21) of the false-negative MR cases concerned pure ductal carcinoma in situ (DCIS) or DCIS with invasive foci, in eight of them no enhancement was seen at the review. In six patients the features of malignancy were missed or misinterpreted. Small lesion size (n = 3), extensive diffuse contrast enhancement of the breast parenchyma (n = 2), and a technically inadequate examination (n = 1) were other causes of the missed diagnosis. A major part of the false-negative MR diagnoses concerned non-enhancing DCIS, underlining the necessity of screening not only with MRI but also with mammography. Improvement of MRI scanning protocols may increase the detection rate of DCIS. The missed and misinterpreted cases are reflecting the learning curve of a multicenter study. http://repub.eur.nl/res/pub/7182/ 2005-12-01T00:00:00Z "Women with a BRCA1 or BRCA2 mutation, who have a considerable increased risk of developing breast cancer, now face the choice of intensive screening, prophylactic surgery or chemoprevention. The efficacy of the various medical options and the durability of its effects are of major concern to female BRCA1/2 mutation carriers, and will influence their choices. Although prophylactic mastectomy reduces the rate of breast cancer risk of 90 % or more, the intervention is irreversible, with potential harms that may be unacceptable for certain women. This thesis shows that intensive screening is an appropriate alternative to reduce the risk of breast cancer death for both BRCA1/2 mutation carriers and for women with a clear family history of breast cancer where a mutation has not (yet) been found. Intensive screenings expected to lead to significant breast cancer mortality reductions with no adverse effect on short-term generic health-related quality of life and general distress. Including magnetic resonance imaging in BRCA1/2 mutation carriers (50-85% cumulative lifetime risk for developing breast cancer) surveillance is cost-effective. For moderate-risk women (15-30% cumulative lifetime risk for developing breast cancer), intensive screening with only mammography, alternatively in combination with clinical breast examination, is most cost-effective."