From the Guidelines
Breast MRI is recommended for individuals at high risk for breast cancer, including those with a strong family history, known genetic mutations like BRCA1 or BRCA2, or a personal history of breast cancer, particularly those with dense breast tissue or diagnosed before age 50. The American College of Radiology (ACR) recommends annual breast MRI surveillance for women with a lifetime risk of breast cancer of 20% or greater, or those with a personal history of breast cancer and dense breasts, or those diagnosed with breast cancer before age 50 1. Some key points to consider when deciding who needs a breast MRI include:
- A strong family history of breast or ovarian cancer
- Known genetic mutations like BRCA1 or BRCA2
- Personal history of breast cancer, particularly those with dense breast tissue or diagnosed before age 50
- History of radiation therapy to the chest before age 30
- Certain genetic syndromes like Li-Fraumeni or Cowden syndrome
- Women with breast implants to check for ruptures
- Dense breast tissue where mammograms may be less effective The ACR also recommends considering annual surveillance with breast MRI in women with a personal history of breast cancer and dense breast tissue, or those diagnosed before age 50 1. However, breast MRI is not recommended as a routine screening tool for all women due to its higher cost, potential for false positives, and the need for specialized equipment and expertise in interpretation 1. It's essential to weigh the benefits and risks of breast MRI and consider individual patient factors, such as risk level and medical history, when deciding who needs a breast MRI 1.
From the Research
Individuals Who Need a Breast MRI
The following individuals may benefit from a breast MRI:
- Women with BRCA1 or BRCA2 gene mutations, as they are at high risk for developing breast cancer 2, 3, 4, 5, 6
- Women with a strong family history of breast or ovarian cancer, as they may also be at increased risk for developing breast cancer 5
- Women who have undergone risk-reducing mastectomy, as they may still require regular breast screening 4
Screening Strategies
Different screening strategies have been studied, including:
- Annual screening with mammography and MRI, starting at age 25 years 2, 4
- Alternating mammography and MRI at 6-month intervals, starting at age 25 or 30 years 2, 6
- Annual MRI, with delayed alternating mammography, starting at age 25 or 30 years 2, 6
Effectiveness of Breast MRI
Breast MRI has been shown to be more sensitive than mammography, ultrasound, and clinical breast examination in detecting breast cancers in high-risk women 3, 4, 5