The utility for breast MRI surveillance in patients with a personal history of breast cancer depends upon associated risk factors of the studied populations, as well as institutional protocols. The ACR recommends annual breast MRI surveillance for any woman with a lifetime risk of breast cancer of ~20% or greater [8,10]. Annual breast MRI is recommended for women with a personal history of breast cancer and dense breasts as well as women diagnosed with breast cancer before 50 years of age [10], because these risk factor combinations likely result in a ~20% or greater estimated lifetime risk of developing breast cancer [10,62,63]. Annual breast MRI is also recommended for women with a mammographically occult primary breast cancer [62,63]. A large observational study from BCSC data of 812,164 women compared mammographic and MRI performance in women with and without a personal history of breast cancer. They found MRI was more likely to be performed in patients with a family history of breast cancer and personal history of breast cancer and in women with dense breast tissue. There were higher biopsy rates with MRI (6.3%) compared with mammography (2.2%), with lower cancer yield (19.5% versus 34.7%, respectively) [64]. The findings of higher cancer detection rates with MRI compared with mammography, with lower specificity and positive predictive value were confirmed [65,66]. Another large community-based study from BCSC data of 13,266 women with a personal history of breast cancer compared surveillance with MRI and mammography to mammography alone. The group with breast MRI had higher biopsy rates (odds ratio, 2.2) and cancer detection rates (odds ratio, 1.7), with no significant difference in sensitivity or interval cancers. This study did not control for confounders and suggested subgroup analysis was warranted to better delineate risks and benefits of breast MRI in this patient population [67].
Imaging after Breast Surgery. The utility for breast MRI surveillance in patients with a personal history of breast cancer depends upon associated risk factors of the studied populations, as well as institutional protocols. The ACR recommends annual breast MRI surveillance for any woman with a lifetime risk of breast cancer of ~20% or greater [8,10]. Annual breast MRI is recommended for women with a personal history of breast cancer and dense breasts as well as women diagnosed with breast cancer before 50 years of age [10], because these risk factor combinations likely result in a ~20% or greater estimated lifetime risk of developing breast cancer [10,62,63]. Annual breast MRI is also recommended for women with a mammographically occult primary breast cancer [62,63]. A large observational study from BCSC data of 812,164 women compared mammographic and MRI performance in women with and without a personal history of breast cancer. They found MRI was more likely to be performed in patients with a family history of breast cancer and personal history of breast cancer and in women with dense breast tissue. There were higher biopsy rates with MRI (6.3%) compared with mammography (2.2%), with lower cancer yield (19.5% versus 34.7%, respectively) [64]. The findings of higher cancer detection rates with MRI compared with mammography, with lower specificity and positive predictive value were confirmed [65,66]. Another large community-based study from BCSC data of 13,266 women with a personal history of breast cancer compared surveillance with MRI and mammography to mammography alone. The group with breast MRI had higher biopsy rates (odds ratio, 2.2) and cancer detection rates (odds ratio, 1.7), with no significant difference in sensitivity or interval cancers. This study did not control for confounders and suggested subgroup analysis was warranted to better delineate risks and benefits of breast MRI in this patient population [67].