The Who, What, Where, When and Sometimes, Why.

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.

Mammography plus breast MRI, compared to mammography alone, can increase detection of breast cancer in some women with an increased risk of breast cancer.

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 higher than average risk, including those with [1]:

Breast MRI isn’t recommended as part of breast cancer screening 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.

Learn more about breast MRI.

Study measures (sensitivity and specificity)

The main goal of any cancer screening test is to correctly identify everyone who has cancer (called the sensitivity of the test). For example, a sensitivity of 90 percent means 90 percent of people tested who truly have cancer are correctly identified as having cancer.

An ideal cancer screening test would also be able to correctly identify all the people who don’t have cancer as not having it (called the specificity of the test). For example, a specificity of 90 percent means 90 percent of the people who don’t have cancer are correctly identified as not having cancer.

When sensitivity is high, the test picks up even the slightest abnormal finding. Very few cases are missed, but the test will mistake some people as having cancer when they don’t (called a false positive result).

When specificity is high, there are few false positive results, but more cases of true cancer are missed.

No screening test has perfect sensitivity and perfect specificity. There’s always a trade-off between the two. That is, when a test gains sensitivity, it loses some specificity.

Learn more about the quality of screening tests.

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 mutation or having a family history suggesting a BRCA1 or BRCA2 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.

StudyStudy Population
(number of participants)
SensitivitySpecificity
MammographyBreast MRIMammographyBreast MRI
Clinical trials

Kriege et al. [2]

1,909
(51 cases)

40%

71%

95%

90%

Kuhl et al. [3]

529
(43 cases)

33%

91%

97%

97%

Leach et al. [4]

649
(35 cases)

40%

77%

93%

81%

Hagen et al. [5]

491
(25 cases)

50%

86%

N/A

N/A

Warner et al. [6]

236
(22 cases)

38%

85%

100%

93%

Pooled and meta-analyses

Phi et al. [7]

2,226 women
with a strong family history, but no known gene mutation
(87 cases)

55%

89%

94%

83%

Phi et al. [8]

1,219 women
with a BRCA1 gene mutation
(112 cases)

36%

94%

89%

84%

 

732 women
with a BRCA2 gene mutation
(72 cases)

45%

93%

80%

85%

Warner et al. [9]

11 studies

32%

75%

99%

96%

Granader et al. [10]

8 studies

38%

97%

96%

91%

 

StudyStudy Population
(number of participants)
Breast MRI plus Mammography
SensitivitySpecificity
Clinical trials

Kuhl et al. [3]

529
(43 cases)

93%

96%

Leach et al. [4]

649
(35 cases)

94%

77%

Pooled and meta-analyses

Phi et al. [8]

2,226 women
with a strong family history, but no known gene mutation
(87 cases)

98%

79%

Phi et al. [8]

1,219 women
with a BRCA1 gene mutation
(112 cases)

93%

80%

 

732 women
with a BRCA2 gene mutation
(72 cases) 

93%

81%

Warner et al. [9]

11 studies

84%

95%

Granader et al. [10]

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

  1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast cancer screening and diagnosis, Version 1.2019, http://www.nccn.org, 2020.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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. 
  9. 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.
  10. 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.

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