Cancers need to increase their blood supply in order to grow. On a breast MRI, the contrast tends to become more concentrated in areas of cancer growth, showing up as white areas on an otherwise dark background. This helps the radiologist determine which areas could possibly be cancerous. More tests may be needed after breast MRI to confirm whether or not any suspicious areas are actually cancer.
For the breast MRI, you will need to pull down your hospital gown to your waist or open it in front to expose your breasts. Then you lie on your stomach on a padded platform with cushioned openings for your breasts. Each opening is surrounded by a breast coil, which is a signal receiver that works with the MRI unit to create the images. The platform then slides into the center of the tube-shaped MRI machine. You won’t feel the magnetic field and radio waves around you, but you will hear a loud thumping sound. You will need to be very still during the test, which takes around 30 to 45 minutes.
Who should have breast MRI for screening?
Yearly mammograms plus breast MRI screening are typically recommended for women who are at higher-than-average risk of developing breast cancer — in other words, at greater than the average 13% risk most women have over the course of an entire lifetime.
The American Cancer Society (ACS) recommends that all high-risk women — those with a greater than 20% lifetime risk of breast cancer — have a breast MRI and a mammogram every year. For most women, these combined screenings should start at age 30 and continue as long as the woman is in good health. According to ACS guidelines, high-risk women include those who:
• have a known BRCA1 or BRCA2 gene mutation
• have a first-degree relative (mother, father, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation and have not had genetic testing themselves
• find out they have a lifetime risk of breast cancer of 20-25% or greater, according to risk assessment tools that are based mainly on family history
• had radiation therapy to the chest for another type of cancer, such as Hodgkin’s disease, when they were between the ages of 10 and 30 years
• have a genetic disease such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have one of these syndromes in first-degree relatives
The American Cancer Society also recommends that women at moderately increased risk of breast cancer — those with a 15-20% lifetime risk — talk with their doctors about the possibility of adding breast MRI screening to their yearly mammogram. According to ACS guidelines, this includes women who:
• find out they have a lifetime risk of breast cancer of 15-20%, according to risk assessment tools based mainly on family history
• have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), or abnormal breast cell changes such as atypical ductal hyperplasia or atypical lobular hyperplasia
• have extremely dense breasts or unevenly dense breasts when viewed by mammograms
Why breast MRI is not recommended for screening all women
Breast MRI is not recommended as a screening tool for women who are at average risk of developing breast cancer. Yes, breast MRI has been found to be more sensitive in detecting cancers than mammograms, which does seem like an advantage. However, a major disadvantage is that breast MRI screening results in more false positives — in other words, the test finds something that initially looks suspicious but turns out not to be cancer.
If breast MRI were adopted as a screening tool for everyone, many women would end up having unnecessary biopsies and other tests, not to mention the anxiety and distress. That is why current recommendations reserve breast MRI screening for high-risk women only.
All information is from breastcancer.org
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