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Recommendations for Breast MRI Screening as an Adjunct to Mammography
Recommend Annual MRI Screening (Based on Evidence*)
- BRCA mutation
- First-degree relative of BRCA carrier, but untested
- Lifetime risk ~20-25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history
Recommend Annual MRI Screening (Based on Expert Consensus Opinion**)
- Radiation to chest between age 10 and 30 years
- Li-Fraumeni syndrome and first-degree relatives
- Cowden and Bannayan-Riley-Ruvalcaba syndromes and first-degree relatives
Insufficient Evidence to Recommend for or Against MRI Screening***
- Lifetime risk 15-20%, as defined by BRCAPRO or other models that are largely dependent on family history
- Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
- Atypical ductal hyperplasia (ADH)
- Heterogeneously or extremely dense breast on mammography
- Women with a personal history of breast cancer, including ductal carcinoma in situ (DCIS)
Recommend Against MRI Screening (Based on Expert Consensus Opinion)
- Women at <15% lifetime risk
- * Evidence from nonrandomized screening trials and observational studies.
- ** Based on evidence of lifetime risk for breast cancer.
- *** Payment should not be a barrier. Screening decisions should be made on a case-by-case basis, as there may be particular factors to support MRI. More data on these groups is expected to be published soon.