What are the guidelines for use of magnetic resonance mammography (breast MRI) to screen for breast cancer?

Updated: Feb 25, 2019
  • Author: Preeti Gupta, MD, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Breast MRI is costly, is not as widely available as mammography, and needs injection of contrast medium. Optimal MRI imaging of breasts is performed between days 7 and 14 of a woman's menstrual cycle to avoid the confounding background parenchymal enhancement. It can give rise to a larger number of false positives leading to unnecessary biopsies. Therefore, there are guidelines for performing breast MRI. [3, 19, 4, 5]

There is not enough evidence to make a recommendation for or against yearly MRI screening for women who have a moderately increased risk of breast cancer (a lifetime risk of 15-20% according to risk-assessment tools that are based mainly on family history) or who may be at increased risk of breast cancer based on certain factors, such as (1) having a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH) or (2) having dense breasts (“extremely” or “heterogeneously” dense) as seen on a mammogram.

If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is a more sensitive test (it’s more likely to detect cancer than a mammogram), it may still miss some cancers that a mammogram would detect.

For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. However, because the evidence is limited about the best age at which to start screening, this decision should be based on shared decision-making between patients and their health care providers, taking into account personal circumstances and preferences.


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