The incremental CDR of MRI in elevated-risk women ranges from 8 to 29 per 1,000 women, with lower CDR estimates in intermediate-risk women compared to high-risk BRCA mutation carriers [61-63,65,66]. In one study, breast MRI CDR was 15 per 1,000 in women with a prior biopsy demonstrating a high-risk lesion compared to 8 per 1,000 in women reporting a family history [65]. In women with a personal history of breast cancer, a meta-analysis estimated a CDR of 9 to 15 per 1,000 breast MRI [67]. Breast MRI detects small, node-negative invasive cancers at earlier tumor stages compared to mammography, as well as ductal carcinoma in situ [68,69]. Screening MRI also reduces interval cancers [69]. However, breast MRI has a higher recall rate than mammography (15.1% versus 6.4%) [70], higher frequency of BI-RADS category 3 assessment than mammography (14.8% versus 11.8%), and greater frequency of image-guided biopsies than mammography (11.8% versus 2.4%) [63]. MRI Breast Without IV Contrast There is no relevant literature to support the use of breast MRI without IV contrast for screening women at intermediate risk. MRI Breast Without IV Contrast Abbreviated There is no relevant literature to support the use of abbreviated breast MRI without IV contrast for screening women at intermediate risk. Sestamibi MBI Data are limited regarding the use of sestamibi MBI for screening women at intermediate risk. Most studies have focused upon women with dense breasts and variable risk profiles. Retrospective and prospective studies have demonstrated similar incremental CDR for sestamibi MBI of 6.5 to 9 over mammography, with a study demonstrating an incremental CDR of 16.5 per 1,000 in women at increased risk primarily due to family or personal history of breast cancer [40,47]. Sestamibi MBI demonstrates similar sensitivity, better specificity, and lower recall rate compared to supplemental screening US in women with dense breasts [47,48].
Female Breast Cancer Screening. The incremental CDR of MRI in elevated-risk women ranges from 8 to 29 per 1,000 women, with lower CDR estimates in intermediate-risk women compared to high-risk BRCA mutation carriers [61-63,65,66]. In one study, breast MRI CDR was 15 per 1,000 in women with a prior biopsy demonstrating a high-risk lesion compared to 8 per 1,000 in women reporting a family history [65]. In women with a personal history of breast cancer, a meta-analysis estimated a CDR of 9 to 15 per 1,000 breast MRI [67]. Breast MRI detects small, node-negative invasive cancers at earlier tumor stages compared to mammography, as well as ductal carcinoma in situ [68,69]. Screening MRI also reduces interval cancers [69]. However, breast MRI has a higher recall rate than mammography (15.1% versus 6.4%) [70], higher frequency of BI-RADS category 3 assessment than mammography (14.8% versus 11.8%), and greater frequency of image-guided biopsies than mammography (11.8% versus 2.4%) [63]. MRI Breast Without IV Contrast There is no relevant literature to support the use of breast MRI without IV contrast for screening women at intermediate risk. MRI Breast Without IV Contrast Abbreviated There is no relevant literature to support the use of abbreviated breast MRI without IV contrast for screening women at intermediate risk. Sestamibi MBI Data are limited regarding the use of sestamibi MBI for screening women at intermediate risk. Most studies have focused upon women with dense breasts and variable risk profiles. Retrospective and prospective studies have demonstrated similar incremental CDR for sestamibi MBI of 6.5 to 9 over mammography, with a study demonstrating an incremental CDR of 16.5 per 1,000 in women at increased risk primarily due to family or personal history of breast cancer [40,47]. Sestamibi MBI demonstrates similar sensitivity, better specificity, and lower recall rate compared to supplemental screening US in women with dense breasts [47,48].