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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 Screeing***

  • 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 brease 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

  1. * Evidence from non-randomized screening trials and observational studies.
  2. ** Based on evidence of lifetime risk for breast cancer.
  3. *** 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.