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The American Cancer Society recommends that women at very high risk of developing breast cancer have
annual breast MRI exams in addition to annual
mammograms to increase the likelihood that breast
cancer will be detected early, when the chances of survival are greatest. According to the
Society, MRI (magnetic resonance imaging) is more sensitive than mammography and can help detect cancer that may
be missed by mammography. However, because this increased sensitivity can also lead to false positive
results, which requires unnecessary breast biopsy procedures, the Society does not recommend MRI for all women.
Mammography is a special type of x-ray imaging used to create detailed images of the breast. It is currently
considered the gold standard in breast cancer detection, able to spot approximately 80% of
cancers. MRI is another type of imaging test that uses powerful magnetic fields and radio waves to
create images of the breast. It is usually used as a problem-solving technology to investigate
breast concerns first detected with mammography, physical exam, or other imaging exams.
For most women, the American Cancer Society recommends that they receive annual mammograms beginning at age 40, annual
clinical breast exams beginning at age 20, and perform
monthly breast self exams. However, women at high risk of breast
cancer, as determined by a physician, may benefit from beginning mammography as young as age 30 and those at
very high risk may also benefit from concurrent breast MRI exams.
The American Cancer Society recommends breast MRI exams for women with one of the following:
- a BRCA1 (breast cancer gene 1) or BRCA2 (breast cancer gene 2) mutation
- a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be
tested themselves --a lifetime risk of breast cancer oft 20%-25% or greater, based on one of several accepted risk
assessment tools that consider family history and other factors -a history of radiation to the chest between
the ages of 10 and 30
- 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
Women should consult their physicians to determine their lifetime breast cancer risk.
The American Cancer Society reports that research indicates a possible benefit of using MRI on breast cancer patients
to screen for breast cancer in the opposite breast. However, it says research does not suggest that women
who have 15% to 20% lifetime of developing breast cancer, based on one of several accepted risk assessment tools that
examine family history and other factors, would benefit from MRI exams. Similarly, the Society reports that MRI
exams are not recommended for women with lobular carcinoma in situ (LCIS) or atypical lobular
hyperplasia, atypical ductal hyperplasia, very dense breasts or unevenly dense breasts, or a history of breast cancer.
Benefits
of Breast MRI |
Limitations
to Breast MRI |
- Sensitive to small abnormalities
- Effective in dense breasts
- Can image breast implants/ruptures
- Can evaluate inverted nipples
- Can locate primary tumor in women whose cancer
spread to armpit lymph nodes
- Can detect residual cancer after lumpectomy
- Can determine what type of surgery is
indicated: lumpectomy or mastectomy
- Can detect cancer recurrence after lumpectomy
- May be useful to screen women at high breast
cancer risk
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- Non-specific; often cannot distinguish
cancerous and non-cancerous tumors
- May lead to unnecessary, difficult to perform
biopsies
- Cannot image calcifications, tiny calcium
deposits that can indicate early breast cancers
- Expensive and not widely available
- Expensive
- Some patients who are claustrophobic may not
tolerate MRI
- Requires use of contrast agent
- More time-consuming than mammography
- MRI centers cannot always produce results cited
in research studies
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Additional Resources and References
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