Breast MRI Guidelines
A recently released set of guidelines suggests ways to think about the use of breast MRI in screening. Many women who have had breast cancer, especially those whose tumors were not found by mammography, wonder whether an annual breast MRI should be part of their care.
The controversy about this test's value is generally related to discussions re policy for screening for large numbers of women, not whether one individual might benefit. The disadvantage is that MRIs do result in more false positives--that is "things" that require a biopsy and turn out not to be cancer. These situations do, of course, cause anxiety and distress to the woman involved and are expensive. Most of us would deflect those concerns and feel that we would rather be anxious and then relieved.
Since I have had two primary breast cancers, I do have an annual breast MRI and am sure it is the right choice for my situation. If you are wondering about this, have a conversation with your doctor. Here is a summary of the guidelines released by the NCCN (National COmprehensive Cancer Network) in December and a link if you want to read more:
The 2009 NCCN Clinical Practice Guidelines in Oncology for Breast Cancer Screening and Diagnosis include significant updates for the role of MRI in screening women at increased risk for breast cancer. The NCCN now recommends considering breast MRI as an adjunct to annual mammography and clinical breast examination for women who have a BRCA1 or -2 mutation or who have a first-degree relative who has a BRCA1 or -2 mutation but who have not undergone genetic testing themselves; those who are determined to have a lifetime risk greater than 20% based on models that are highly dependent on family history; and those with a history of lobular carcinoma in situ. MRI is also recommended for patients who underwent radiation treatment to the chest between 10 and 30 years of age, and in those who carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni, Cowden, and Bannahyan- Riley-Ruvalcaba syndromes). MRI is specifically not recommended for screening women at average risk for breast cancer. This article describes the peer-reviewed, published clinical research trials evaluating breast MRI in high-risk patients, on which the NCCN guidelines were based, and provides suggestions for future research.