MRI or mammograms for detecting breast cancer in families with unknown genetic mutations?

Expert Guidelines

The National Comprehensive Cancer Network (NCCN) establishes guidelines for women with increased risk (a lifetime risk for breast cancer of 20 percent or more). The guidelines recommend the following screening:

• Have clinical exams every 6–12 months, starting when you are identified as being at increased risk, but not before age 21.
• Consider consulting with a genetic counselor or similarly trained health care provider, if you haven’t already done so.
• Consider consulting with a breast surgeon.
• Start annual mammography screening at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 30. Consider getting a 3-D mammogram.
• Begin annual breast MRI at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 25.
• Consider recommended risk reduction strategies, such as preventive hormonal medications.
• Develop breast awareness and report any changes to your health care providers.

NCCN has separate guidelines for breast screening in women with an inherited mutation. See our gene-by-gene listing to find specific risk-management guidelines for people with an inherited mutation linked to cancer.  

Questions To Ask Your Health Care Provider

• What method of screening or combination of methods do you recommend given my personal and family history?
• What are the benefits and risks of screening by MRI and by mammogram?
• What follow-up would you recommend if my breast MRI comes back with an abnormal finding?
• How often should I be screened for breast cancer?
• Will my insurance cover breast cancer screening?

Open Clinical Trials

The following are breast cancer screening or prevention studies enrolling people at high risk for breast cancer.   

• NCT04711109: Denosumab for Preventing Breast Cancer in Women with a BRCA1 Inherited Mutation (BRCA-P). This study will test the effectiveness of a drug (denosumab) on preventing the development of breast cancer in women with an inherited BRCA1 mutation.
• NCT04067726: Denosumab and Mammographic Density in Premenopausal Women With Dense Breasts (TRIDENT). This study is looking at the drug denosumab to learn if it can reduce breast density in high-risk premenopausal women who have dense breasts. 
• The Risk Factor Analysis of Hereditary Breast and Ovarian Cancer In Women  with BRCA1, BRCA2 or PALB2 Mutations.  This study seeks to improve researchers’ understanding of how hormonal, reproductive and lifestyle factors may be associated with cancer in high-risk people.
• NCT02620852: Women Informed to Screen Depending on Measures of Risk (WISDOM) study.  The goal of this study is to determine if breast cancer screening can be made better by personalizing each woman’s mammogram schedule, compared to the current one-size-fits-all, annual approach.

Additional risk-management clinical trials for people at high risk for breast cancer may be found here.