Magnetic Resonance Imaging Screening of Women at High Risk for Breast Cancer

Patient Population

Women at very high risk for breast cancer, ‘very high risk’ being defined as:

1. Known mutation in BRCA1, BRCA2 or other gene predisposing to a markedly elevated breast cancer risk.
2. Untested first-degree relative of a carrier of such a gene mutation.
3. Family history consistent with a hereditary breast cancer syndrome and estimated personal lifetime cancer risk >25%.
4. High-risk marker on prior biopsy (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ [LCIS]).
5. Radiation therapy to chest (before age 30 and at least eight years previous).

Research Question(s)

1. What is the effectiveness of adding breast magnetic resonance imaging (MRI) to standard screening (mammography) compared to screening mammography alone?
2. Does the addition of breast MRI to standard screening detect breast cancer at an earlier stage?
3. What is the optimal frequency of MRI screening?
4. Are there subgroups (risk category, age, or breast density) that benefit more from MRI screening than do others?
5. What harms are associated with MRI screening, and are there any relative or absolute contraindications to its use?
6. In the presence of an abnormal finding seen only on MRI imaging, what is the optimal workup and follow-up after screening?