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Hereditary Cancer Info > Risk Management > Breast Cancer Screening

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Breast Cancer Screening

Learn about the steps that people at high risk for cancer can take to manage their risk and protect their health.

Magnetic Resonance Imaging

Breast Magnetic Resonance Imaging (MRI) is an imaging method that uses magnetic fields rather than X-rays to produce a detailed picture of the breasts. The National Comprehensive Cancer Network and other experts recommend MRI with contrast for screening of women who are at high risk for breast cancer, including:

  • women with mutations in BRCA1, BRCA2, PALB2, ATM, CDH1, CHEK2, PTEN, STK11, NBN, NF1 and TP53
  • women whose lifetime risk of breast cancer is greater than 20%, based on their family history.

MRI can be useful, but it has some drawbacks. It is less specific than some other screening tests for breast cancer. Although MRI is sensitive and may pick up an abnormality missed by other techniques, there is a greater chance for the abnormality to be benign. Unfortunately, a biopsy is required to determine if a change is cancerous—women who undergo breast MRI are more likely to have biopsies for changes that are not cancerous. Although this lower specificity may not be acceptable for screening of women of average risk, many experts believe the benefit of MRI outweighs the risk for women with hereditary risk for breast cancer.

Because MRI is still a relatively expensive test, not all insurance companies will pay for it, even in women with a known BRCA mutation. Further, not all facilities have MRIs specifically made for imaging the breast or radiologists capable of interpreting breast MRI results, and some facilities are not set up for MRI-guided biopsy; even if the facility has a breast MRI, it may not have the capability to biopsy an MRI-detected abnormality not seen by mammography or ultrasound.

Some women are concerned about the safety of the gadolinium contrast agent that is used during breast MRI. However, because gadolinium is a metal, it is given in a form that is rapidly removed from the body, limiting side effects and making it safe for most patients. Precautions are often taken when using gadolinium-containing contrast agents in patients who have had allergic reactions to imaging agents, women who are pregnant or nursing, and patients with kidney disease who are risk for a rare kidney disorder known as nephrogenic systemic fibrosis if they are exposed to gadolinium.

The long-term effects of gadolinium-based contrast agents remain an area of research.  Experts on our advisory board feel that the benefits from enhanced contrast on breast MRIs outweigh the theoretical risks. They continue to recommend annual breast MRI with contrast for women at high-risk for breast cancer who have not undergone mastectomy.

Updated 11/18/16

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