The American Cancer Society recommends that women at very high ris MRI Screening Recommended for Some Women at Very High Risk of Breast Cancer (dateline April 2, 2007) | Breast Health News | Imaginis - The Women's Health & Wellness Resource Network

The Women's Health Resource. On the web since 1997.

MRI Screening Recommended for Some Women at Very High Risk of Breast Cancer (dateline April 2, 2007)

The American Cancer Society recommends that women at very high risk of developing breast cancer have annual breast MRI exams in addition to annual mammograms to increase the likelihood that breast cancer will be detected early, when the chances of survival are greatest. According to the Society, MRI (magnetic resonance imaging) is more sensitive than mammography and can help detect cancer that may be missed by mammography. However, because this increased sensitivity can also lead to false positive results, which requires unnecessary breast biopsy procedures, the Society does not recommend MRI for all women.

Mammography is a special type of x-ray imaging used to create detailed images of the breast. It is currently considered the gold standard in breast cancer detection, able to spot approximately 80% of cancers. MRI is another type of imaging test that uses powerful magnetic fields and radio waves to create images of the breast. It is usually used as a problem-solving technology to investigate breast concerns first detected with mammography, physical exam, or other imaging exams.

For most women, the American Cancer Society recommends that they receive annual mammograms beginning at age 40, annual clinical breast exams beginning at age 20, and perform monthly breast self exams. However, women at high risk of breast cancer, as determined by a physician, may benefit from beginning mammography as young as age 30 and those at very high risk may also benefit from concurrent breast MRI exams.

The American Cancer Society recommends breast MRI exams for women with one of the following:

  • a BRCA1 (breast cancer gene 1) or BRCA2 (breast cancer gene 2) mutation
  • a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves --a lifetime risk of breast cancer oft 20%-25% or greater, based on one of several accepted risk assessment tools that consider family history and other factors -a history of radiation to the chest between the ages of 10 and 30
  • Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative

Women should consult their physicians to determine their lifetime breast cancer risk.

The American Cancer Society reports that research indicates a possible benefit of using MRI on breast cancer patients to screen for breast cancer in the opposite breast. However, it says research does not suggest that women who have 15% to 20% lifetime of developing breast cancer, based on one of several accepted risk assessment tools that examine family history and other factors, would benefit from MRI exams. Similarly, the Society reports that MRI exams are not recommended for women with lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia, atypical ductal hyperplasia, very dense breasts or unevenly dense breasts, or a history of breast cancer.

Benefits of Breast MRI

Limitations to Breast MRI

  • Sensitive to small abnormalities
  • Effective in dense breasts
  • Can image breast implants/ruptures
  • Can evaluate inverted nipples
  • Can locate primary tumor in women whose cancer spread to armpit lymph nodes
  • Can detect residual cancer after lumpectomy
  • Can determine what type of surgery is indicated: lumpectomy or mastectomy
  • Can detect cancer recurrence after lumpectomy
  • May be useful to screen women at high breast cancer risk
  • Non-specific; often cannot distinguish cancerous and non-cancerous tumors
  • May lead to unnecessary, difficult to perform biopsies
  • Cannot image calcifications, tiny calcium deposits that can indicate early breast cancers
  • Expensive and not widely available
  • Expensive
  • Some patients who are claustrophobic may not tolerate MRI
  • Requires use of contrast agent
  • More time-consuming than mammography
  • MRI centers cannot always produce results cited in research studies

Additional Resources and References