Should I have breast MRI to screen for breast cancer?

The Center for Medical Genetics has expertise in breast cancer risk assessment.  We have considerable experience using and clinically validating the breast cancer risk models recommended by the American Cancer Society to determine whether you should add breast magnetic resonance imaging (MRI) to your breast cancer screening regimen.

The American Cancer Society (ACS) recently published guidelines for the use of MRI of the breast, in addition to mammograms, to screen for breast cancer.  A number of recent studies have found that breast MRI, in combination with mammography and clinical breast examinations, is an effective screening tool for women at high risk of developing breast cancer.  Breast MRI has the ability to detect early breast cancers not seen on a mammogram or felt by a physician.  It is also important to note that some cancers are not found by MRI but only by mammography or a physician’s examination. Therefore, MRI is NOT a replacement for standard breast cancer detection tools such as mammography or physical exam and should be used in combination with these methods.

One key component to the ACS guidelines is the recommendation of offering breast MRI to women at high risk of developing breast cancer.  The ACS defined high risk as women who have:

  • A BRCA1 or BRCA2 mutation or a first degree relative (parent, sibling or child) with a BRCA1 or BRCA2 mutation, who have not undergone genetic testing themselves
  • Li-Fraumeni syndrome (a hereditary cancer syndrome caused by the p53 gene) or first degree relatives of an individual with Li-Fraumeni syndrome
  • Cowden syndrome (a hereditary cancer syndrome caused by the PTEN gene) or first degree relatives of an individual with Cowden syndrome
  • Received radiation to the chest between the ages of 10-30 (e.g., treatment for Hodgkin’s disease)
  • A lifetime risk of developing breast cancer of ~20-25% or greater, as defined by different statistical models which use family history of cancer to generate a numerical risk

The ACS did not find enough evidence to recommend for or against breast MRI in women who have:

  • A personal history of lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
  • A personal history of atypical ductal hyperplasia (ADH)
  • A personal history of breast cancer including ductal carcinoma in situ (DCIS)
  • Heterogeneously or extremely dense breast tissue on mammography
  • A lifetime risk of developing breast cancer of 15-20%, as defined by different statistical models which use family history of breast and/or ovarian cancer to generate a numerical risk

To determine whether you are eligible for breast MRI in addition to mammogram, please use our online cancer risk assessment tool, MyGenerations™.  You can share your report with your healthcare providers to help develop an individualized plan for early cancer detection and prevention.  MyGenerations™ also serves as a guide as to whether you should seek a genetics consultation and consider genetic testing for one of the conditions included in the ACS guidelines.

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