Breast MRI

Recommendations for Breast MRI Screening as an Adjunct to Mammography

Recommend Annual MRI Screening (Based on Evidence*)

• BRCA mutation
• First-degree relative of BRCA carrier, but untested
• Lifetime risk ~20-25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history

Recommend Annual MRI Screening (Based on Expert Consensus Opinion**)

• Radiation to chest between age 10 and 30 years
• Li-Fraumeni syndrome and first-degree relatives
• Cowden and Bannayan-Riley-Ruvalcaba syndromes and first-degree relatives

Insufficient Evidence to Recommend for or Against MRI Screening***

• Lifetime risk 15-20%, as defined by BRCAPRO or other models that are largely dependent on family history
• Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
• Atypical ductal hyperplasia (ADH)
• Heterogeneously or extremely dense breast on mammography
• Women with a personal history of breast cancer, including ductal carcinoma in situ (DCIS)

Recommend Against MRI Screening (Based on Expert Consensus Opinion)

• Women at <15% lifetime risk

1. * Evidence from nonrandomized screening trials and observational studies.
2. ** Based on evidence of lifetime risk for breast cancer.
3. *** Payment should not be a barrier. Screening decisions should be made on a case-by-case basis, as there may be particular factors to support MRI. More data on these groups is expected to be published soon.