Genetic/Familial High-Risk Screening: MRI Alone?

To reduce the risk of breast cancer, women with a BRCA1 or BRCA2 mutation or with a risk of developing breast cancer above 20-25% are offered intensified screening programs throughout Europe and the United States. International societies have established guidelines for these programs, which may vary from nation to nation. The combined use of mammography, ultrasonography (US), and magnetic resonance imaging (MRI) has the best diagnostic performance and yields the highest detection rates, but also increases the number of false-positive findings and results in increased costs. MRI has widely proven its high sensitivity, outperforming mammography and US in cancer detection. Thus, annual MRI of the breast is recommended for screening women at high risk from age 25 years onward, and to add mammography from age 30-35 years on. The aim of this chapter is to provide a comprehensive overview of the role of the different breast imaging modalities, and, particularly, to determine whether MRI can be used as a single modality in women with a genetic/familial high risk. In addition, we will discuss the impact of screening on survival rates of genetic/familial high-risk women and we will provide insights into the cost-benefit aspects.