Abstract
Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient’s response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.
Highlights
Breast cancer is the most common cancer in women globally and the second leading cause of cancer deaths
The American Cancer Society (ACS) recommends that women at substantially increased risk, defined as a 20% lifetime risk of breast cancer or greater, undergo annual screening contrast-enhanced breast Magnetic resonance imaging (MRI) in addition to annual mammography, as MRI remains the most sensitive imaging modality available for the detection of breast cancer [7]
The robust data obtained with numerous studies investigating the use of screening breast MRI in women at markedly increased risk of breast cancer demonstrates that annual screening with MRI detects earlier, more frequently node-negative and more likely curable breast cancer
Summary
Breast cancer is the most common cancer in women globally and the second leading cause of cancer deaths. While many varying recommendations exist, the data definitively demonstrates that annual mammography beginning at age 40 results in the most lives saved compared to other proposed screening protocols [4] These recommendations are for women at average risk of breast cancer. The ACS recommends that women at substantially increased risk, defined as a 20% lifetime risk of breast cancer or greater, undergo annual screening contrast-enhanced breast MRI in addition to annual mammography, as MRI remains the most sensitive imaging modality available for the detection of breast cancer [7] This group of high-risk women includes those with BRCA 1 or 2 mutations, untested first-degree relatives of BRCA-positive patients, history of chest radiation for Hodgkin’s lymphoma between the ages of 10 and 30 years, and women with PalB2 mutations and other genetic syndromes associated with elevated breast cancer risk [7]. MRI, such as using MRI as a biomarker for breast cancer risk and treatment response, as well as implementing abbreviated protocol breast MRI programs to expand access of screening breast MRI to those who would benefit from it
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