Breast MRI

1. Indications
   1. Breast Cancer Screening in high risk women
      1. BRCA1 or BRCA2 genetic mutation
      2. First degree relative with BRCA1 or BRCA2
      3. Radiation exposure to chest under age 30 years
      4. Lifetime Breast Cancer risk estimated >20%
      5. Other Genetic Syndromes (and an affected 1d relative)
         1. Li-Fraumeni Syndrome
         2. Cowden syndrome
         3. Bannayan-Riley-Ruvalcaba Syndrome
      6. References
         1. Saslow (2007) CA Cancer J Clin 57: 75-89 [PubMed]
   2. Breast Cancer evaluation
      1. Define extent of Breast Cancer index lesion
      2. Identify concurrent cancer in contralateral Breast
      3. Assess response to Chemotherapy
      4. Define new Breast Cancers in those with implants
      5. Assess for suspected residual cancer post-surgery
      6. Inconclusive Mammogram, breast Ultrasound, CBE
      7. References
         1. Silverstein (2005) J Am Coll Surg 201:586-97 [PubMed]
2. Protocol: Breast Cancer Screening
   1. Annual Breast MRI starting at age 30 in high risk women (for indications as above)
   2. Continue Mammograms and Clinical Breast Exams
3. Efficacy: Breast Cancer Screening
   1. Test Sensitivity: 79% (Mammogram: as low as 33%)
   2. Test Specificity: 90% (Mammogram: 95%)
      1. Higher risk of False Positives than Mammogram
   3. References
      1. Kriege (2004) N Engl J Med 351:427-37 [PubMed]
      2. Kuhl (2005) J Clin Oncol 23:8469-76 [PubMed]
4. Disadvantages: Breast Cancer Screening
   1. Too expensive for general population screening
   2. Twice the False Positive Rate (10%) compared with Mammogram (5%)
      1. Would substantially increase unnecessary testing if MRI applied to general population screening
5. Resources
   1. Breast Cancer Risk Assessment Tool
      1. https://bcrisktool.cancer.gov/
6. References
   1. Salzman (2019) Am Fam Physician 99(8): 505-14 [PubMed]