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MRI Twice per Year May Be Better Than Annual Mammogram for Finding Early Breast Cancers in High-Risk Women

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A study suggests that breast cancer screening with MRI twice per year is better than one mammogram per year for finding breast cancer early in young women with a high risk of breast cancer.

The research was published online on Aug. 28, 2018, by the journal Clinical Cancer Research.

Read the abstract of “Intensive surveillance with bi-annual dynamic contrast-enhanced magnetic resonance imaging downstages breast cancer in BRCA1 mutation carriers.”

Between 2004 and 2016, the study enrolled 295 women at high risk for breast cancer, including 157 women with a known genetic mutation linked to breast cancer:

  • 75 women had a BRCA1 mutation
  • 61 women had a BRCA2 mutation
  • 23 women had another mutation linked to breast cancer, such as CDH1

Other factors that put the women at high risk included:

  • being diagnosed with breast cancer or ductal carcinoma in situ (DCIS) before age 35
  • having a mother or sister diagnosed with breast cancer before age 50 (age 40 for Black women)

All the women had a breast exam done by a doctor and an MRI every 6 months, as well as a digital mammogram every 12 months, for the length of the study.

All cancers found were DCIS or node-negative, early-stage disease

Overall, 17 breast cancers were found:

  • 4 were DCIS
  • 13 were early-stage invasive disease

None of the cancers had spread to the lymph nodes. All the cancers detected were smaller than 1 centimeter (cm); the average size was 0.61 cm, about one-quarter of an inch.

Fifteen of the cancers were diagnosed in women with known mutations linked to breast cancer:

  • 11 were in women with a BRCA1 mutation
  • 3 were in women with a BRCA2 mutation
  • 1 was in a woman with a CDH1 mutation

All the women who were diagnosed with cancer were followed after treatment, and all are alive and have no evidence of disease.

Aggressive cancers were detected early

"This study demonstrates for the first time that aggressive breast cancers can be caught early, without excessive recalls or biopsies," said Olufunmilayo Olopade, M.D., the Walter L. Palmer Distinguished Service Professor and associate dean for global health at the University of Chicago Medical Center and senior author of the study.

"[MRI every 6 months] performed well for early detection of invasive breast cancer in genomically stratified high-risk women," said Gregory Karczmar, Ph.D., professor of radiology at the University of Chicago and another study author. "This is the ultimate goal of breast cancer screening, detecting node-negative, invasive tumors less than 1 centimeter."

"Mammograms are not the best option for about 40% of women," Karczmar continued. "This includes those with dense breasts as well as those with significant genetic risks. MRI is much more sensitive than mammography. It can find invasive breast cancers sooner than mammograms, and it can rule out abnormalities that appear suspicious on a mammogram. Unfortunately, MRI is much too expensive for routine screening."

According to Olopade, mammograms are still important for women at average risk, but for women at high risk who are getting an MRI every 6 months, "annual mammograms can be eliminated."

"The central goal of our study was to understand the needs of the highest-risk women," said study co-author Mary Claire King, Ph.D., professor of genome sciences and of medicine at the University of Washington and the American Cancer Society Research Professor for Breast Cancer. "My hope is that mammography and MRI will be used in ways that make sense given a woman's personal genetics. Women with mutations in BRCA1 or BRCA2 have very different needs for surveillance for breast disease than women with no mutations in these genes. This is particularly true for healthy young women with mutations. It's truly critical to offer intensive surveillance to still-healthy women with BRCA1 or BRCA2 mutations."

Most current screening guidelines for women at high risk of breast cancer recommend MRI once per year, as well as a mammogram and breast exam by a doctor once per year.

If you know that you have a high risk of breast cancer because you have a genetic mutation or a personal or family history of breast cancer, it makes sense to talk to your doctor about an aggressive screening plan that starts at an earlier age and possibly includes other screening techniques. You may want to bring up this study and ask if MRI every 6 months makes sense for your unique situation.

There are also lifestyle choices you can make to keep your risk as low as possible, including:

  • maintaining a healthy weight
  • exercising regularly
  • limiting or avoiding alcohol
  • eating nutritious food
  • never smoking

For more information on breast cancer screening tests, visit the Screening and Testing pages.

To talk with others at high risk of breast cancer, join the Discussion Board forum High Risk for Breast Cancer.

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