MRI Screening for Breast Cancer in Women with a Familial or Genetic Predisposition


Mieke Kriege
Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centre, PO Box 5201, 3008 AE Rotterdam, the Netherlands


Current options for BRCA 1/2 mutation carriers to reduce their risk of breast cancer (death) include prophylactic mastectomy, oophorectomy and surveillance. Screening for breast cancer is also offered to women with a familial predisposition for breast cancer, but without a proven BRCA 1/2 mutation. The effectivity of mammographic screening in this group of women is questionable, especially in BRCA 1/2 mutation carriers, due to a low sensitivity. Magnetic resonance imaging (MRI) appeared to be a sensitive imaging method in the diagnostic setting and is therefore being investigated as screening tool in women at high risk of breast cancer. Results of MRI pilot studies showed a very high sensitivity (100%) of MRI in all studies, while sensitivity of mammography was never higher than 50%. Recently, the first results of four large series were published. In these studies, sensitivity of MRI was lower than in the smaller pilot studies, but all found a higher sensitivity for MRI (71–96%) than for mammography (36–43%). All studies except one found a lower specificity for MRI than for mammography. Characteristics of the tumours detected within the screening programme were favourable with respect to size and nodal status. Currently, it appears advisable to offer MRI as a screening tool to proven gene mutation carriers. For genetically susceptible women without a proven gene mutation, more research is warranted to decide which of them should be offered MRI screening.