ABSTRACT

There are six primary indications for breast MRI, and data to support each are summarized below.

14.2.1 Screening

Currently, the American Cancer Society recommends the use of MRI to supplement annual mammographic breast cancer screening for women who have a >20% lifetime risk of breast cancer, which includes women with a strong family history of breast or ovarian cancer, personal history of radiation therapy to the chest between 10 and 30 years of age, BRCA mutation carriers (or rstdegree relatives who are untested), and women affected with a genetic syndrome (or rst-degree relatives who are untested) that portends a high lifetime risk of breast cancer (Table 14.1) [7]. While breast MRI’s sensitivity for breast cancer detection is unrivaled by any other current imaging modality (Figure 14.1), its specicity remains modest; as a result, the risk of additional false-positive abnormalities and associated patient anxiety along with the high cost of MRI relative to mammography has prevented application of breast MRI to the general screening population. However, there is growing evidence to support the use of MRI in the intermediate risk population (lifetime risk of 15%–20%), including patients with a personal history of treated breast cancer or diagnosis of high-risk pathologies, such as lobular neoplasia, that are associated with an elevated lifetime risk of developing breast cancer [8-11].