MRI can detect otherwise occult breast cancer in high-risk patients
and is probably most beneficial to those at highest risk. Data
are accumulating in support of supplementing mammography with
MRI to detect cancer in carriers of
BRCA mutations. MRI may
also be valuable in screening women with an increased risk due
to nongenetic factors (e.g., prior breast cancer), but more
work is needed to substantiate this possibility, including analysis
of the contribution of MRI in subgroups with defined risk factors
and quantified levels of risk. No data support the use of MRI
in screening women at normal risk. Ideally, breast MRI should
be performed at facilities that follow technical and interpretive
guidelines
9 and that can perform biopsies of lesions detected
by MRI alone.
21 Whether the excellent results reported in the
literature can be achieved in practice remains to be determined.
Further outcomes research is essential to develop evidence-based
recommendations for methods of breast-cancer screening that
are tailored to the specific needs of women at various levels
of risk.
