Role of MRI in screening women at high risk for breast cancer.

Breast cancer is diagnosed in over one million women worldwide every year. Until breast cancer can be prevented, early detection offers the best chance for cure. Mammographic screening is an effective method for early detection in average-risk women. However, the sensitivity of mammography is decreased in women at high risk for breast cancer. Because of its high sensitivity, multiple investigators have studied the potential role of MRI in screening women at high risk. In the past few years, results from eight major clinical trials exploring breast MRI as a screening tool have been published. Combined, the studies included 4271 patients and found 144 breast cancers detected by MRI, for an overall cancer yield of 3%. The sensitivity of MRI ranged from 71% to 100% across the studies. Although its reported specificity was variable, the call-back rates and risk of benign biopsies were within acceptable limits. In general, patients who underwent breast MRI screening had a 10% risk of being called back, and a 5% risk of having a benign biopsy. This work reviews the literature and current practices and recommendations for MRI as a screening tool for high-risk women.