Research table: Breast MRI for women at high risk
This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table. |
Introduction: Breast magnetic resonance imaging (MRI) uses magnetic fields to create an image of the breast.
Breast MRI in combination with mammography is better than mammography alone at finding breast cancer in some women at high risk.
Breast MRI isn’t a recommended breast cancer screening tool for women at average risk. It has some drawbacks compared to mammography. For example, it’s more invasive because a contrast agent is given by vein (through an IV) before the procedure.
Who should consider breast MRI as part of screening?
The National Comprehensive Cancer Network recommends breast MRI as part of breast cancer screening for some women at high risk, including those with [1-2]:
- A BRCA1 or BRCA2 (BRCA1/2) inherited gene mutation
- A first-degree relative (parent, sibling or child) with a BRCA1/2 inherited gene mutation, but personally have not been tested for BRCA1/2 mutations
- Radiation treatment to the chest area between ages 10-30
- Li-Fraumeni syndrome or Cowden/PTEN syndrome
- A PALB2, PTEN or TP53 inherited gene mutation
- A greater than 20 percent lifetime risk of invasive breast cancer based mainly on family history (Estimate your lifetime risk or learn more about risk.)
The NCCN recommends some women at high risk of breast cancer consider breast MRI as part of breast cancer screening, including those with [1-2]:
- Lobular carcinoma in situ (LCIS) who also have a greater than 20 percent lifetime risk of invasive breast cancer
- Atypical hyperplasia who also have a greater than 20 percent lifetime risk of invasive breast cancer
- An ATM, BARD1, CDH1, CHEK2 or NF1 inherited gene mutation
Learn more about breast MRI.
Study selection criteria: Clinical trials, pooled analyses and meta-analyses of women at high risk for breast cancer (defined as either having a BRCA1 or BRCA2 (BRCA1/2) inherited gene mutation or having a family history suggesting a BRCA1/2 inherited gene mutation) with at least 20 invasive breast cancer cases.
Table note: The studies presented below compare sensitivity and specificity for screening with mammography alone, breast MRI alone and breast MRI plus mammography.
There are no data comparing survival among women who had mammography alone versus those who had breast MRI plus mammography.
Study |
Study Population |
Sensitivity |
Specificity |
||
Mammography |
Breast MRI |
Mammography |
Breast MRI |
||
Clinical trials |
|||||
Kriege et al. [3] |
1,909 |
40%† |
71%† |
95% |
90% |
Kuhl et al. [4] |
529 |
33% |
91% |
97% |
97% |
Leach et al. [5] |
649 |
40% |
77% |
93% |
81% |
Hagen et al. [6] |
491 |
50% |
86% |
N/A |
N/A |
Warner et al. [7] |
236 |
38% |
85% |
100% |
93% |
Pooled and meta-analyses | |||||
Phi et al. [8] |
2,226 women |
55% |
89% |
94% |
83% |
Phi et al. [9] |
1,219 women |
36% |
94% |
89% |
84% |
|
732 women |
45% |
93% |
80% |
85% |
Warner et al. [10] |
11 studies |
32% |
75% |
99% |
96% |
Granader et al. [11] |
8 studies |
38% |
97% |
96% |
91% |
Study |
Study Population |
Breast MRI plus Mammography |
|
Sensitivity |
Specificity |
||
Clinical trials |
|||
Kuhl et al. [4] |
529 |
93% |
96% |
Leach et al. [5] |
649 |
94% |
77% |
Pooled and meta-analyses | |||
Phi et al. [8] |
1,219 women |
93% |
80% |
732 women |
93% |
81% |
|
Phi et al. [9] |
2,226 women |
98% |
79% |
Warner et al. [10] |
11 studies |
84% |
95% |
Granader et al. [11] |
8 studies |
94% |
86% |
N/A = Results are not available.
* Most results combined cases of invasive breast cancer and ductal carcinoma in situ (DCIS). All studies included at least 20 cases of invasive breast cancer.
† Sensitivity for invasive breast cancers was 33% for mammography and 80% for breast MRI.
References
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast cancer screening and diagnosis, Version 1.2022, http://www.nccn.org, 2022.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Genetic/familial high-risk assessment: breast, ovarian, and pancreatic. Version 2.2022. http://www.nccn.org, 2022.
- Kriege M, Brekelmans CTM, Boetes C, et al. for the Magnetic Resonance Imaging Screening Study Group. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 351(5):427-37, 2004.
- Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 23(33):8469-76, 2005.
- Leach MO, Boggis CR, Dixon AK, et al. for the MARIBS Study Group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 365(9473):1769-78, 2005.
- Hagen AI, Kvistad KA, Maehle L, et al. Sensitivity of MRI versus conventional screening in the diagnosis of BRCA-associated breast cancer in a national prospective series. Breast. 16(4):367-74, 2007.
- Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 292(11):1317-25, 2004.
- Phi XA, Saadatmand S, De Bock GH, et al. Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis. Br J Cancer. 114(6):631-7, 2016.
- Phi XA, Houssami N, Hooning MJ, et al. Accuracy of screening women at familial risk of breast cancer without a known gene mutation: Individual patient data meta-analysis. Eur J Cancer. 85:31-38, 2017.
- Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 148(9):671-9, 2008.
- Granader EJ, Dwamena B, Carlos RC. MRI and mammography surveillance of women at increased risk for breast cancer: recommendations using an evidence-based approach. Acad Radiol. 15(12):1590-5, 2008.
Updated 06/30/22