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Q&A: MRI Needed for High-Risk Breast Cancer

CancerWise - July 2007

Certain women at high risk of developing breast cancer should have a yearly magnetic resonance imaging (MRI) scan in addition to a mammogram because MRI finds more tumors earlier, according to new American Cancer Society (ACS) screening guidelines.

Answering questions about the guidelines and screening practices for high-risk patients in M. D. Anderson's Clinical Cancer Genetics Program is Banu Arun, M.D., co-director of the program and an associate professor in M. D. Anderson's Department of Breast Medical Oncology.

According to the ACS, who needs an MRI?

The new ACS recommendations are specifically for certain women at high risk of developing breast cancer. Men are not included because there is not a lot of data regarding breast screening for men.

The new ACS guidelines target women who have a:

BRCA1 or BRCA2 gene mutation – BRCA mutations, which are identified through blood tests, predispose women to developing breast and ovarian cancer.

Women with BRCA mutations have a 50% to 80% lifelong risk of developing breast cancer, so in our genetics clinic we discuss intensive screening. That means yearly mammograms and yearly MRI scans, which we alternate every six months.

People with BRCA mutations also have a 50% chance of passing it on to their children, who also may need MRI screenings.

First-degree relative with a BRCA mutation – A first-degree relative could be a mother, father, sister, brother, daughter or son.

History of chest radiation (between age 10 and 30) – This would apply to former pediatric cancer patients.

20% to 25% or greater lifetime breast cancer risk – Lifetime risk is determined during a genetic assessment using an accepted cancer risk assessment tool. This questionnaire focuses on personal health history and family history.

First-degree relative with a TP53 or PTEN gene mutation – These mutations are linked to Li-Fraumeni syndrome, Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome, which predispose people to breast cancer and a number of other cancers.

Does M. D. Anderson follow the new guidelines?

Yes. M. D. Anderson has been using MRI scans with mammograms for this high-risk group for the past three to four years.

How valuable have MRIs been in finding cancer?

Very. To give you an example, I've had three patients in the past four months who have been diagnosed with cancer with an MRI when a mammogram did not detect it six months earlier.

Are MRIs recommended for others at high risk?

At this time, the ACS is not recommending MRI scans for anyone else because there is not enough evidence to show benefits outweigh the risks.

MRI scans are not recommended for people who:

  • Have a lifetime breast cancer risk of less than 20%
  • Have lobular carcinoma in situ (LCIS)
  • Have atypical lobular hyperplasia (ALH)
  • Have atypical ductal hyperplasia (ADH)
  • Have already had breast cancer
  • Have dense or unevenly dense breasts (on mammogram)

However, these people should talk to their health care provider to discuss what screening tests are appropriate for them.

We have recommended MRI scans for some women on a case-by-case basis, but that is only after thorough risk assessments, which may include genetic testing.

Why aren’t MRI scans recommended for all women?

MRI scans pick up a greater number of suspicious spots than mammograms. That means they report more false positives than mammograms, and that raises the risk or possibility of unnecessary biopsies (the removal of cells or tissue to determine if cancer is present).

Ruling out all suspicious spots through MRI is important to those who have a high risk of breast cancer because tumors can grow faster and be more aggressive in those women.

How can people find out if they need an MRI scan?

They should talk to their doctors and ask if genetic counseling is right for them in determining their risk and eligibility for MRI screening.

Genetic services are provided through many cancer centers and other health care institutions.

Can anyone be tested to see if they need an MRI?

Anyone can request an appointment for genetic counseling. Testing will not be recommended for everyone.

If a young woman comes to our genetics clinic and says "I have a sister who was diagnosed with breast cancer at 35, and I want to have genetic testing done," we tell the patient that a first-degree relative developing a cancer at a young age puts her at risk for developing breast cancer, but we need to test her sister first.

Why would a cancer patient need genetic testing?

If a cancer patient has a BRCA mutation, we could watch for cancer developing in the noncancerous breast using MRI screenings.

If a cancer patient is tested and a BRCA mutation is found, they could be given new drugs that target the BRCA mutation. They also might elect to have preventive surgery.

Does insurance cover MRI scans and genetic services?

Many insurance companies do cover these procedures, but patients should check with their health insurance companies.

For more information about the Clinical Cancer Genetics Program, call 713-745-7391.

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© 2014 The University of Texas MD Anderson Cancer Center