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 Breast MRI is not recommended as a routine screening
tool for all women. However, it is recommended for screening
women who are at high risk for breast cancer, usually due to
a strong family history and/or a mutation in genes such as BRCA1
or BRCA2. If you are considered high-risk, you would have breast
MRI in addition to your annual mammograms (x-rays of the breast).
Breast MRI is not a perfect tool. Although it
is generally considered more sensitive for picking up breast
cancer than mammography, it also can miss some cancers that would
be detected by mammography. That is why breast MRI is recommended
only in combination with other tests, such as mammogram or ultrasound.
Yearly mammograms plus breast MRI screening are
typically recommended for women who are at higher-than-average
risk of developing breast cancer — in other words, at greater
than the average 13% risk most women have over the course of
an entire lifetime.
The American Cancer Society (ACS) recommends that
all high-risk women — those with a greater than 20% lifetime
risk of breast cancer — have a breast MRI and a mammogram
every year. For most women, these combined screenings should
start at age 30 and continue as long as the woman is in good
health. According to ACS guidelines, high-risk women include
those who:
- have a known BRCA1 or BRCA2 gene mutation
- have a first-degree relative (mother, father,
brother, sister, or child) with a BRCA1 or BRCA2 gene mutation
and have not had genetic testing themselves
- find out they have a lifetime risk of breast
cancer of 20-25% or greater, according to risk assessment tools
that are based mainly on family history
- had radiation therapy to the chest for another
type of cancer, such as Hodgkin’s disease, when they
were between the ages of 10 and 30 years
- have a genetic disease such as Li-Fraumeni
syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome,
or have one of these syndromes in first-degree relatives
The American Cancer Society also recommends that
women at moderately increased risk of breast cancer — those
with a 15-20% lifetime risk — talk with their doctors about
the possibility of adding breast MRI screening to their yearly
mammogram. According to ACS guidelines, this includes women who:
- find out they have a lifetime risk of breast
cancer of 15-20%, according to risk assessment tools based
mainly on family history
- have a personal history of breast cancer, ductal
carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS),
or abnormal breast cell changes such as atypical ductal hyperplasia
or atypical lobular hyperplasia
- have extremely dense breasts or unevenly dense
breasts when viewed by mammograms
If you think you’re a candidate for breast
MRI screening, talk to your doctor. You and your doctor may need
to work with your health insurance plan to get the test covered.
You may have to prove to your plan that you are indeed considered
high-risk for breast cancer. You also will need to find a facility
with dedicated breast MRI screening equipment.
Breast MRI is not recommended as a screening tool
for women who are at average risk of developing breast cancer.
Yes, breast MRI has been found to be more sensitive in detecting
cancers than mammograms, which does seem like an advantage. However,
a major disadvantage is that breast MRI screening results in
more false positives — in other words, the test finds something
that initially looks suspicious but turns out not to be cancer.
If breast MRI were adopted as a screening tool for everyone,
many women would end up having unnecessary biopsies and other
tests, not to mention the anxiety and distress. That is why current
recommendations reserve breast MRI screening for high-risk women
only.
MRI is also more expensive than mammography,
and dedicated breast MRI screening equipment is not widely
available.
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