The American Cancer Society has issued these recommendations related to breast cancer screening with MRI in high-risk women.
Women with an approximately 20 to 25 percent or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated with mantle radiation for Hodgkin disease under the age of 30. There are several risk subgroups, including those with a personal history of treated breast cancer for which the available data are insufficient to recommend for or against MRI screening. There is also insufficient evidence to recommend MRI for women with increased risk due to atypia or LCIS. Please check with your doctor.
MRI can be helpful in very high-risk women, but it is associated with high chance of false positive exams. It should be stressed that conventional mammography is very effective in the broad spectrum of women at average risk for breast cancer. Please speak with your doctor about your specific case.
The decision regarding when to initiate screening should be based on shared decision-making between patients and their health care providers, taking into consideration individual circumstances and preferences. The most appropriate age to begin screening depends on an individual patient’s risk factors. For women with known or suspected BRCA 1 or 2 mutations screening should begin at age 25. For other women at high risk, they should discuss with their doctors and contact the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program.
Several different programs are available for calculating a woman’s breast cancer risk.
The various breast cancer risk models utilize different combinations of risk factors, have been derived from different data sets, and vary in the age to which they calculate cumulative breast cancer risk. As a result, they may generate different risk estimates for a given patient, so please check with your doctor.
The B-PREP Program is available to help patients and healthcare providers determine the appropriate risk model to use for a given patient. The B-PREP program will provide screening recommendations based on your level of risk as well as options and resources for risk reduction.
Our B-PREP Program enables women and men of all ages, including those with or without a family history of cancer, to take charge of their breast health. Throughout the entire process, our experienced and compassionate doctors, nurses and breast specialists will be by your side, guiding and advising.
It is not necessary for all women to undergo genetic testing. The B-PREP program will help determine if genetic testing is appropriate. You are encouraged to talk to your doctor about your specific case.
For the majority of women at high risk, it is critical that MRI screening be provided in addition to, not instead of, mammography, as the sensitivity and cancer yield of MRI and mammography combined is greater than for MRI alone. In other words, while many cancers will be detected by both MRI and mammography, some cancers are detectable only by MRI and some are detectable only by mammography.
As with mammography and other screening tests, false negative and false positive results do occur. False negatives can lead to missed cancer diagnoses, with potentially worse prognosis; false positives may lead to increased anxiety and potential harms associated with interventions for benign lesions.
The specificity of MRI is significantly lower than that of mammography in all studies to date, resulting in more call-backs and biopsies. The call-back and biopsy rates of MRI are higher than for mammography; however, the increased sensitivity of MRI leads to a higher number of cancers detected in high risk populations.
Most of the major plans will cover MRI screening if the patient’s physician can demonstrate that it is appropriate based on the risk profile.
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