Q: When is MRI appropriate for breast cancer screening?
The American Cancer Society (ACS) recommends MRI in conjunction with mammograms for women at very high risk. MRI is not to be used in place of mammograms for breast cancer screening.
Bryan Gushiken, M.D.
Breast Radiologist
Q: Who falls in the "very high risk" category?
According to the ACS, women who meet the following guidelines, should have an MRI annually with their mammogram. Most plans cover this exam with at least one of the following criteria with a pre-authorization:
- BRCA1 or BRCA2 mutation
- first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
- 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
- received radiation treatment to the chest between the ages of 10 and 30
- has 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
Q: Why not use MRI to screen all women?
While it is true, MRI is more sensitive than mammograms, it is also more likely to detect abnormalities in the breast which may or may not be cancer. Often, the only way to make a definitive diagnosis is through biopsy. MRI results in more false positives than mammograms. Understandably, it leads to fear and anxiety for the patient, and many unnecessary biopsies. Thus, MRI is not recommended for the woman at average risk, and careful screening is important.
Q: How can I get an MRI?
If you believe you meet the guidelines, please talk with your doctor first. If your doctor refers you for an MRI, a thorough history and evaluation will be completed to confirm that an MRI is appropriate before the exam is ordered.
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