Breast MRI Cancer Screening

Magnetic resonance imaging (MRI) of the breast — or breast MRI — is a breast imaging technique that captures multiple cross-sectional pictures of your breast and combines them via computer to generate detailed, two-dimensional and three-dimensional pictures.

Breast MRI is a valuable tool that is used to evaluate the extent of disease in patients with newly diagnosed breast cancer, and a tool sometimes used in addition to and in conjunction with a mammogram or other breast-imaging test when screening high-risk patients.

Breast MRI is not a replacement for a mammogram because although it’s a very sensitive test, a breast MRI can still miss some breast cancers that a mammogram will detect. In fact, the MRI procedure is so sensitive that it often finds many benign areas that require further investigation but are not breast cancer.

 To help identify high-risk patients, the American Cancer Society (ACS) developed guidelines to define two types of patients: an average-risk patient and a high-risk patient.

For an average-risk patient — The ACS recommends against breast MRI as a routine screening method. Women who fall into this category should receive an annual mammography beginning at age 40.

For a high-risk patient — considered to be a woman who meets the criteria outlined by the ACS (listed below). It is recommended that an annual breast MRI be performed in addition to the woman’s annual mammogram.

What constitutes high risk?

• According to the ACS, a high-risk patient is considered to be a woman who has one or more of the traits listed below:
• inherited mutation in the genes called BRCA1 and BRCA2 (short for breast cancer 1 and breast cancer 2), which are involved in many cases of hereditary breast and ovarian cancer
• a first-degree relative of a known breast cancer gene (BRCA) carrier
• a lifetime cancer risk of 20 to 25 percent or greater, as defined by BRCA-PRO (a computer model used by genetics counselors for determining genetic risk)
• a history of having received chest irradiation (radiation therapy) between
  the ages of 10 and 30 years
• Li-Fraumeni, Cowden, or Bannayan- Riley-Ruvalcaba syndromes
• diagnosis of both breast and ovarian cancer
• family history that includes multiple cases of early-onset breast cancer
• one or more male family members who have been diagnosed with breast cancer
• Ashkenazi Jewish background and a family history of breast and ovarian cancer

It’s important to point out that a personal history of breast cancer alone does not necessitate an annual breast MRI. While the ACS does offer suggestions for average- and high-risk patients, it makes no recommendation for those who have a history of atypical cytology (abnormal cells are present) on breast biopsy with no known genetic mutation. Women with abnormal results are eligible for Magee High-Risk Breast Cancer Program services, such as counseling, increased surveillance, or assessment for chemo prevention.

Calculating risk

Patients who wish to determine an estimate of their five-year and lifetime risk of invasive breast cancer on their own can access a number of different statistical models, such as the Gail model or the National Cancer Institute’s breast cancer risk assessment tool via the Internet. While these statistical tools can serve as a good benchmark, the results should not be used as a basis for determining the need for breast MRI.

If you’re unsure whether you’re a candidate for a breast MRI, ask your doctor to help you determine your personal risk estimate.

Reviewed January 2013