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.

The main goal of any cancer screening test is to correctly identify everyone who has cancer. This is 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. This is 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. This is 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 (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 (number of participants)	Sensitivity		Specificity
Study	Study Population (number of participants)	Mammography	Breast MRI	Mammography	Breast MRI
Clinical trials
Kriege et al. [3]	1,909 (51 cases)	40%^†	71%^†	95%	90%
Kuhl et al. [4]	529 (43 cases)	33%	91%	97%	97%
Leach et al. [5]	649 (35 cases)	40%	77%	93%	81%
Hagen et al. [6]	491 (25 cases)	50%	86%	N/A	N/A
Warner et al. [7]	236 (22 cases)	38%	85%	100%	93%
Pooled and meta-analyses
Phi et al. [8]	2,226 women with a strong family history, but no known gene mutation (87 cases)	55%	89%	94%	83%
Phi et al. [9]	1,219 women with a BRCA1 inherited gene mutation (112 cases)	36%	94%	89%	84%
	732 women with a BRCA2 inherited gene mutation (72 cases)	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 (number of participants)	Breast MRI plus Mammography
Study	Study Population (number of participants)	Sensitivity	Specificity
Clinical trials
Kuhl et al. [4]	529 (43 cases)	93%	96%
Leach et al. [5]	649 (35 cases)	94%	77%
Pooled and meta-analyses
Phi et al. [8]	1,219 women with a BRCA1 inherited gene mutation (112 cases)	93%	80%
	732 women with a BRCA2 inherited gene mutation (72 cases)	93%	81%
Phi et al. [9]	2,226 women with a strong family history, but no known gene mutation (87 cases)	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

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