What are the ACS recommendations for annual magnetic resonance mammography (breast MRI)?

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

Answer

The American Cancer Society (ACS) recommends annual MRI screening along with mammography, based on evidence from nonrandomized screening trials and observational studies, in women with the following risk factors [4] :

  • BRCA mutation

  • First-degree relative of BRCA carrier, but untested

  • Lifetime risk ∼20–25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history

The ACS recommends annual MRI screening, based on expert consensus opinion that considers evidence of lifetime risk for breast cancer, in women with the following risk factors [4] :

  • Radiation to chest between age 10 and 30 years

  • Li-Fraumeni syndrome or first-degree relatives with the syndrome

  • Cowden and Bannayan-Riley-Ruvalcaba syndromes or first-degree relatives with those syndromes

The ACS found insufficient evidence to recommend for or against MRI screening in women with the following risk factors  [4] :

  • Lifetime risk 15–20%, as defined by BRCAPRO or other models that are largely dependent on family history

  • Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)

  • Atypical ductal hyperplasia (ADH)

  • Heterogeneously or extremely dense breast on mammography

  • Personal history of breast cancer, including ductal carcinoma in situ (DCIS)

The ACS recommends against MRI screening (based on expert consensus opinion) in women at < 15% lifetime risk.

Finally, the ACS advises that screening decisions should be made on a case-by-case basis, as there may be particular factors to support MRI. Payment should not be a barrier.


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