In the March/April, 2007 issue of CA CancerJournal of Clinicians the American Cancer Society (ACS) published guidelines for the use of magnetic resonance imaging for screening of women at high risk of developing breast cancer. This is the first such guideline since 2002-2003.

Several recent studies have suggested that MRI adds significantly to the accuracy of detecting early breast cancers in high-risk women screened by clinical breast exam, ultrasonography, and mammography. The current ACS guidelines conclude that MRI scans are more sensitive than mammograms for the detection of breast cancer.

The ACS screening guidelines include:

• Average risk women should continue to receive annual mammograms and breast exams beginning at age 40 years.
• Most high-risk women should begin MRI and mammogram screening at age 30 years

  High risk women are defined as:

• Women with BRCA1 or BRCA2 mutation.
• Women who have a first degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet  to be tested themselves.
• Women who have a 20-30% risk of breast cancer based on risk assessment tools
• Women who have had radiation to the chest between the ages of 10 and 30 years.
• Women who have 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.
• Women who have had breast cancer should have MRI screening of the opposite breast. Presumably this would also include the affect breast in patients with lumpectomy.

Comments: These guidelines should be helpful in determining who would benefit from MRI. However, this is a not a static issue as newer studies are being performed all the time which may assist in determining who should and who should not receive an MRI. In addition, there is also progress in using ultrasonography in conjunction with mammography for increased accuracy in detecting early breast cancer.

 Reference: Saslow D, Burke W, Leach MO, et al. American Cancer Society Guidelines for breast cancer screening with MRI as a adjunct to mammography. CA Cancer J Clin 2007;57:75-89.

 Related News:

MRI May Increase Breast Cancer Detection in High-Risk Women (02/09/2007)

MRI Cost-Effective for Selected Women with BRCA1 or BRCA2 Mutations (05/26/2006)

MRI Prior to Surgery in Early Breast Cancer Helps Guide Treatment Decisions (10/25/2005)

MRI More Effective than Mammography for BRCA1 and BRCA2 Carriers (09/21/2004)

MRI More Effective than Mammography for Women at High-Risk of Breast Cancer (08/06/2004)

German Researchers Suggest MRI to Replace Screening Mammography for Familial Breast Cancer (6/4/2003)