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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:
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 concern has been expressed about the safety of the gadolinium contrast agent that is used during breast MRI. The FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks. Experts on our Advisory Board agree.