MRI in breast cancer

Question 1

Who qualifies for MRI screening?

2012 AHS guidelines

Answer 1

High Risk Women:

1) known BRCA-1 or BRCA-2 mutation, TP-53 (Li-Fraumeni), PTEN (Cowden)
2) known first degree family member with BRCA-1/2, TP-53, PTEN mutations
3) history of chest radiation- age 10-30 (i.e. Hodgkin’s disease, mantle cell lymphoma- NHL)
4) personal lifetime risk of developing breast cancer >20-25% according to models dependent on family history (i.e. Boadicea, IRISS)

Question 2

MRI screening interval?

Answer 2

q12 month intervals

Question 3

Who should not get screened by an MRI?

2012 AHS guidelines

Answer 3

Insufficient evidence to do MRI on:

1) Lifetime risk of breast cancer 15-20% (defined by models based on family hx)
2) LCIS
3) ALH, ADH
4) heterogeneously or extremely dense breasts on mammo with no other risk features
5) personal history of breast cancer, but do not otherwise fit into high risk category

Question 4

Who qualifies for a pre-operative MRI?

2012 AHS guidelines

Answer 4

• axillary adenocarcinoma with unknown primary
• discordant clinical and mammographic/ultrasound findings
• evaluate response to neoadjuvant chemo
• assess extent of disease in DCIS and IDC
• assess invasion to deep fascia
• evaluate possible recurrence
• invasive lobular carcinoma (evidence that it reduces re-excision surgery, but increased likelihood of upfront mastectomy)