Breast Imaging In High Risk Women, The Role of MRI
For many years, screening mammography has been the “gold standard” in detecting early breast cancer in all women regardless of underlying risk factors. With the development of new breast imaging technologies, namely breast MRI, the screening strategy for women with especially high risk of developing breast cancer has changed. MRI has been shown in numerous scientific studies to be the most sensitive test for detecting early breast cancer (greater than 95% in some studies).
As a result, of these studies the American Cancer Society (ACS) has revised its recommendations regarding breast MRI. Its most recent guidelines published in 2007 recommend MRI screening in addition to mammography for women who meet one of the following criteria:
They have a BRCA1 or BRCA2 mutation
They have a first-degree relative (parent, sibling, child) with a
BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
Their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
They had radiation to the chest between the ages of 10 and 30
They have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative
As expressed by Christy Russell, MD, Chair of the ACS Breast Cancer Advisory Board, “These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than using mammography alone.”