Does an MRI detect the BRCA (Breast Cancer) gene?

From the Guidelines

MRI does not have the BRCA gene, and genetic testing is necessary to determine if an individual carries a BRCA mutation. The BRCA gene (BRCA1 and BRCA2) is a human gene that helps suppress tumor formation, and mutations in these genes increase the risk of breast and ovarian cancers. MRI, or Magnetic Resonance Imaging, is a medical imaging technique used to visualize internal structures of the body. While MRI can be used as a screening tool for individuals who carry BRCA gene mutations to detect breast cancer early, the imaging technology itself does not contain or test for the BRCA gene.

According to the most recent guidelines, annual breast MRI screening is recommended for women with a BRCA1/2 pathogenic or likely pathogenic variant, starting at age 25 1. This is because MRI has been shown to have higher sensitivity in detecting breast cancers in high-risk women compared to mammography, with a sensitivity of 77%–94% compared to 33%–59% for mammography 1.

Some key points to consider:

• The American Cancer Society recommends annual breast MRI for breast cancer screening in high-risk women, including those with BRCA gene mutations 1.
• The ACR recommends annual breast MRI in high-risk women beginning as early as 25 years of age 1.
• MRI has been shown to detect small, node-negative invasive cancers at earlier tumor stages compared to mammography, as well as ductal carcinoma in situ 1.
• However, breast MRI has a higher recall rate than mammography, higher frequency of BI-RADS category 3 assessment, and a greater frequency of image-guided biopsies than mammography 1.

If you're concerned about your BRCA status, you would need genetic testing, typically done through a blood or saliva sample. This testing is often recommended for individuals with a strong family history of breast, ovarian, or certain other cancers. The results of genetic testing, not MRI scans, would determine if you carry a BRCA mutation. Genetic testing is the only way to determine if an individual carries a BRCA mutation, and it is essential for identifying individuals who may benefit from early screening and preventive measures.

From the Research

MRI and BRCA Gene

• MRI is used as a screening tool for breast cancer in individuals with BRCA1 and BRCA2 gene mutations 2, 3, 4, 5.
• Studies have shown that MRI is more sensitive than mammography, ultrasound, and clinical breast examination in detecting breast cancers in BRCA1 and BRCA2 mutation carriers 3, 4.
• The combination of MRI and mammography has been found to have a higher sensitivity (94%) compared to mammography alone (39%) in detecting breast cancers in BRCA1 and BRCA2 mutation carriers 4.
• Annual screening with MRI and mammography is recommended for BRCA1 and BRCA2 mutation carriers, starting at age 25 or 30 2, 4, 5.

Screening Strategies

• Different screening strategies have been evaluated, including alternating digital mammography (DM) and MRI, and annual MRI with delayed alternating DM 2.
• The most effective screening strategy may depend on the individual's risk factors and personal preferences, as well as the radiation risk model used 2.
• The addition of MRI to mammography has been found to lower the specificity, but this improves significantly after the first round of screening 4.

Management of BRCA Mutation Carriers

• Bilateral mastectomy is considered the gold standard for primary prevention of breast cancer in BRCA1 and BRCA2 mutation carriers 5.
• Chemoprevention options are also being explored as a potential management strategy for BRCA mutation carriers 5.
• Clinical practice guidelines for BRCA1 and BRCA2 genetic testing have been updated to include recommendations for personalized management of early and metastatic breast cancer, as well as testing indications for PARP inhibitor therapy 6.