Breast MRI Cancer Screening
Magnetic resonance imaging (MRI) of the breast — or breast MRI — is a breastimaging technique that captures multiple cross-sectional pictures of your breast and combines them via computer to generate detailed, two-dimensional and threedimensional 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 false indicators of 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 — considered to be a woman with no cancer symptoms — the ACS recommends against breast MRI as a routine screening method.Women who fall into this category should receive an annual mammography and clinical breast examination beginning at age 40.
For a high-risk patient — considered to be a woman who meets the criteria outlined by the ACS — 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, itmakes 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.