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MRI Urged for High Breast Cancer Risk

American Cancer Society Recommends Annual Breast MRI for Very High-Risk Women
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Which Women Need Breast MRI? continued...

"The actual number of women seeking MRI screening in addition to mammography is expected to be much lower than 1 in 50 -- at least for the foreseeable future," say Debbie Saslow, PhD, ACS director of breast and gynecologic cancer, and Robert Smith, PhD, ACS director of cancer screening, in a statement released to WebMD.

Other women may benefit from MRI screening, but there's not yet enough evidence to include them in the screening recommendation. The ACS says "the jury is still out" on whether the benefits of MRI screening outweigh the risks for women with:

  • A 15%-20% lifetime risk of breast cancer, based on one of several accepted risk-assessment tools that look at family history and other factors
  • Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
  • Atypical ductal hyperplasia (ADH)
  • Very dense breasts or unevenly dense breasts (when viewed on a mammogram)
  • Previously diagnosed breast cancer, including ductal carcinoma in situ (DCIS)

The new recommendation comes with a warning: Not all doctors' offices have the proper MRI equipment. Women should not get MRI screening at a practice that does not also offer MRI-guided biopsies, the ACS warns.

MRI Helps Women With New Breast Cancer

Separately, a new study complements the ACS recommendations. It shows that for women with a new diagnosis of cancer in one breast, MRI is much better than mammography for determining whether the other breast carries a cancer. Constance Lehman, MD, PhD, director of breast imaging at the University of Washington and Seattle Cancer Care Alliance, was one of the study’s researchers.

"This means that instead of those women having another cancer diagnosis years after their initial treatment, we can diagnose and treat those opposite-breast cancers at the time of the initial diagnosis," Lehman says in a news release.

Perhaps more importantly, MRI can all but rule out cancer in the second breast.

"Although no imaging tool is perfect, if the MRI is negative, the chance of cancer in that breast is extremely low," Lehman notes. "A potential outcome that we would be delighted to see is fewer unnecessary bilateral mastectomies."

Lehman and colleagues report their findings in the March 29 issue of The New England Journal of Medicine.

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