Women with Breast Cancer History Should Consider Annual MRI

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A yearly mammogram may not be adequate for women who have had breast cancer, according to a new study presented at the annual Radiological Society of North America meeting. For this population of women, an MRI should be considered as well.

Mammogram plus MRI suggested for breast cancer survivors

Screening guidelines for breast cancer have been confusing, to say the least, in recent times. The American Cancer Society (ACS), for example, recommends yearly mammograms for all women beginning at age 40, while the US Preventive Services Task Force recommends beginning screening at age 50 and then only every other year until age 75.

The Centers for Disease Control and Prevention suggest women 40 to 49 talk to their doctor about a mammogram and that women 50 to 74 have a screening mammogram every two years. In addition, the American College of Radiology and the Society of Breast Imaging recommend beginning screening mammography at age 40 for women with an average risk of breast cancer and by age 30—but not before 25—among those at higher risk.

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For women who have a personal history of breast cancer, the guidelines from the ACS state that there is not enough evidence to recommend these women have an MRI, although the guidelines do recommend yearly breast MRIs among women who have a known gene mutation or a strong family history of the disease placing them at greater than a 20 percent risk.

Now Wendy B. DeMartini, MD, assistant professor in the Department of Radiology at the University of Washington Medical Center and Seattle Cancer Care Alliance, and her team are suggesting a new guideline for women who have had breast cancer. They base the new recommendations on a retrospective review of MRI examinations of 1,026 women, 327 of whom had a genetic or family history of breast cancer and 646 who had a personal history of treated breast cancer.

The investigators found that “using breast MRI screening, we actually detected proportionally more cancers in women with a personal history of breast cancer, compared with those women with a genetic mutation or strong family history who are currently recommended to have breast MRI,” according to DeMartini.

Specifically, MRI screening found 25 of 27 cancers, and the cancer yield in women who had had breast cancer (3.1%) was twice that of the women who had a genetic or family history (1.5%). DeMartini explained that “our findings show that the diagnostic performance of MRI in patients with a personal history of treated breast cancer supports consideration” of an annual MRI in addition to a mammogram.

SOURCES:
American Cancer Society
Centers for Disease Control and Prevention
Radiological Society of North America
US Preventive Services Task Force

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