Breast MRI Detects Cancers in Women with High-Risk Lesions

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Screening with breast MRI may be particularly useful in patients with a high-risk lesion who also have a family history of breast cancer, according to a preliminary analysis of research presented at a poster session on Saturday at the San Antonio Breast Cancer Symposium.

Among 83 women with a high-risk lesion, specifically atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ, MRI identified cancer in seven women—six of whom had a family history of the disease. All cancers were detected during the first four years of screening. An additional 32 women had a biopsy after a suspicious MRI, with no cancer found.

Options for women at high risk for breast cancer include close surveillance with mammography, preventive bilateral mastectomy, and chemopreventive drugs, such as tamoxifen. Investigators noted, however, that these interventions aren’t widely implemented.

The analysis may help guide women who would benefit from breast MRI screening, but research is still needed to determine whether breast cancer detection with MRI impacts survival and is cost-effective.

The American Cancer Society currently recommends annual MRI screening plus mammography for women who:

have a BRCA1 or BRCA2 mutation

have a first-degree relative (such as a mother, sister, or daughter) with a BRCA1 or BRCA2 mutation and are untested

have at least a 20 to 25 percent lifetime risk of breast cancer using standard risk assessment models

received radiation therapy to the chest between ages 10 and 30 to treat cancer, such as for Hodgkin disease

carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni syndrome and Cowden and Bannayan-Riley-Ruvalcaba syndromes)

The guidelines, released in 2007, further stated that available data were insufficient to recommend for or against MRI screening for women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breast tissue on mammography.

A different study in BRCA1 or BRCA2 mutation carriers found that MRI screening plus mammography detected breast cancer at an earlier stage than mammography alone. Watch for complete coverage of this and other screening research in Monday’s newsletter.

This article is a part of CURE’s 2009 San Antonio Breast Cancer Symposium coverage. To read more articles from SABCS 2009, visit sabcs2009.curetoday.com.