Mammography and MRI for Women with High Risk of Breast Cancer

Women at high risk of breast cancer should get annual mammograms plus MRIs
By Caitlin Lopez, M.D., and Susan Gazzillo, R.N., M.S.N. 

We know for a fact that annual mammograms for women starting at age 40 absolutely save lives. But we also now know that for women at higher risk of breast cancer due to family history and other factors, an additional layer of screening – specifically annual MRI scans – can provide another life-saving measure of early detection.  For women with known genetic mutations, those two annual screening tests should begin at age 30, according to a new recommendations issued this month from the American College of Radiology.

Women overall in the U.S. have a roughly 12 percent lifetime risk of getting breast cancer. That means that for every eight women in the U.S., one will be diagnosed with breast cancer during her lifetime. In an assessment based on family history, personal medical history and other variables, women are considered to be at high risk if their lifetime risk of breast cancer is 20 percent or greater.

So, what are those risk factors?  Well, simply being a woman and getting older for starters. But it’s important to understand that the risk factors themselves do not cause breast cancer; they simply increase the chance it may develop. Having several risk factors for breast cancer does not mean you definitely will get breast cancer. Conversely, most of the women who develop breast cancer have no known risk factors aside from being female.  That’s why it’s important that all women, regardless of their risk profile, remain vigilant and get screened annually.

Some factors that may increase risk of breast cancer

• Inherited mutation in the BRCA1 or BRCA2 breast cancer genes
• Family history of breast, ovarian or prostate cancer
• High breast density on a mammogram
• Exposure to large amounts of radiation
• Have had radiation therapy to breast area under the age of 30
• Biopsy showing Atypical Hyperplasia or Lobular Carcinoma in situ (LCIS)
• Having first period before age 12
• Starting menopause after age 55
• Never having had children
• Having first child after age 35
• Current or past use of birth control pills
• Current or past use of post-menopausal hormones
• High bone density
• Gaining weight in adulthood or being overweight after menopause
• More than one alcohol drink per day

To know whether or not you fall into the high-risk category, talk to your relatives about your family health history and share that knowledge with your physician. Your doctor will then review your personal medical history, your current health condition and personal lifestyle factors to calculate your risk of developing breast cancer. If it’s determined you’re at high risk, you may need to talk about alternate additional screening measures and risk reduction strategies.

Screening recommendations for women at high risk of breast cancer:

• Annual mammography starting at age 40 or earlier, depending on known risk factors.
• Annual breast MRI. Screening through magnetic resonance imaging (MRI) can locate some small breast lesions sometimes missed by mammography. It can also help detect breast cancer in younger women who tend to have dense breast
• Genetic testing for BRCA1/BRCA2 or other genes that may increase the risk of breast cancer.
• If such genetic mutations are present, annual mammography and MRIs should begin at age 30.
• Additional preventive measures, primarily related to lifestyle.

Women at average or intermediate risk (less than 20 percent) are advised to continue following the routine breast screening recommendation: annual mammography starting at age 40.  Women at intermediate risk who also have been told they have high breast density based on a mammogram should talk with their physician about additional screening.

Caitlin Lopez, M.D., is medical director of the Women’s Imaging Center at Berkshire Medical Center.  Susan Gazzillo, R.N., M.S.N., is administrative director of the BMC Cancer and Infusion Center.