Women defined as high-risk are as follows:
- Women with a BRCA1 or BRCA2 gene mutation—this predicts a high likelihood of breast cancer diagnosis.
- Women with a first-degree relative—parent, sibling, child—with a BRCA1 or BRCA2 mutation.
- Women with a lifetime breast cancer risk scored at 20 to 25 percent or greater, based on accepted risk assessment tools that consider family history and other factors.
- Women who had radiation therapy to the chest between the ages of 10 and 30.
- Women with Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or with a family history of these syndromes.
Breast MRI might be beneficial for other groups of women—those with a lifetime risk of 15 to 20 percent, those with dense breasts, those with a personal history of breast cancer—but there is currently not enough evidence to recommend for or against the scans for these populations.
There is also some evidence that MRI might help detect breast cancer in patients’ opposite breasts. Published in the New England Journal of Medicine, a study of 969 newly-diagnosed breast cancer patients turned up 30 opposite-breast early-stage tumors that were not found during physical exams or mammograms. Only three tumors were missed.
It is important to note that some doctors, regardless of evidence and recommendations, may prescribe MRI scans for women they believe would benefit from the screening. I am one such woman—sent by my oncologist to the MRI clinic every six months because he believes my personal history of breast cancer is enough to warrant all testing available. I am happy to submit to every test available. It makes me feel safe to be in the revolving medical system—and in the MRI tube too, despite the cost: about $1,600: $260 of it my patient responsibility.
MRI scans are safe and while the examination may not be advisable for some—those with metal implants, severe lung disease, uncontrollable gastroesophageal reflux, and claustrophobia—they are appropriate for many.
The entire breast MRI experience lasts for about one hour—about half of the time the (potential) breast cancer patient rests on her back and the other half she rests on her stomach, with both breasts hanging freely into cushioned areas. The whole process begins with the placement of all personal belongings—watch, wallet, credit cards with magnetic strips, jewelry—in a secure space. Then the patient dresses in a hospital gown, enters the MRI area, reclines on a flat surface, which is automatically led into a tube. Once the scan begins, a loud thumping sound rings out for bursts of time. Other than the sound, there are no other sensations.
