The American Cancer Society recently recommended MRI screening in addition to mammography screening in women aged 30 and over who are at a high risk for developing breast cancer. A recently completed study also indicated that MRI screening of the opposite breast in women newly diagnosed with breast cancer will find about 3% of cancers that were missed on mammography.

No mention was made of the use of breast ultrasound as an additional screening tool in a dense breast. Actually in experienced hands, with a negative mammogram and a negative ultrasound there is a less than 1% chance of missing a cancer (false negative rate). This is the same false negative rate as a negative MRI!

The advantage of mammography and ultrasound together in dense breasts, is that there are fewer unnecessary biopsies, it is significantly less expensive and, I think more user friendly for the patient. Experienced radiologists have been performing mammography and breast ultrasound a lot longer than breast MRI and we know what we need to biopsy and what we can safely not worry about. We have statistics accumulated over many years to back us up.

The biggest disadvantage of screening breast ultrasound that it is very consuming of the radiologist%u2019s time and therefore not available everywhere, and it does not find noninvasive breast cancer (Ductal Carcinoma In Situ). It also does not add additional information in fatty replaced breast tissue. A lot of insurances do not reimburse for screening ultrasound.

In high risk young women with dense breasts, MRI will find a significant number of additional cancers, but remember, so will ultrasound. I feel strongly that screening with MRI should be recommended with knowledge of family history, available genetic information, the appearance of the breast on the mammogram and pertinent medical history ( previous radiation to chest area for example).

Most importantly breast MRI is extremely dependant on dedicated breast coils (which most MRI centers do not have) and I think even more importantly on meticulous attention to technique. MRIs can look totally normal because they were not performed correctly!

As a radiologist specializing in breast imaging, my biggest concern is that there will be a rush towards screening with MRI in centers that are not qualified to perform it. Even excellent radiologists will be totally fooled by a poorly performed MRI of the breast. As of now there is no policing of MRI centers performing breast MRIs, such as is in place for mammography, and this will lead to huge expense, unnecessary anxiety and biopsies, a false sense of security for the patient and little additional accurate information.

Best regards,
Belinda Barclay-White, MD