In one study, 4 breast cancers in 3 patients were detected on high-risk screening MRI [7]. It may be helpful to wait until 3 months after cessation of breastfeeding. However, if a woman plans to nurse for a long period, or is at very high risk for breast cancer, screening breast MRI during lactation may be considered [10]. The amount of gadolinium excreted in human breast milk over the first 24 hours after IV contrast administration is <1% of the permitted dose for neonates [42]. Up-to-date recommendations with regard to breastfeeding following IV administration of gadolinium are outlined in detail in the ACR Manual on Contrast Media [33]. Therefore, although not the initial imaging tool of choice, screening breast MRI is not contraindicated during lactation and may be considered in lactating women with a high lifetime risk of breast cancer. An informed decision should be made by the mother regarding continuation of breastfeeding after the examination [3,33,42]. Sestamibi MBI There is no role for molecular breast imaging (MBI) in breast cancer screening during lactation. Mammography and DBT Screening mammography can be performed in pregnant women at high risk. Mammography is not contraindicated during pregnancy, and the dose to the fetus is negligible. The fetal radiation dose from a 4-view mammogram is <0.03 mGy. No teratogenic effects have been demonstrated below 50 mGy [43]. Screening mammography is not recommended for pregnant women who are at average or intermediate risk for breast cancer. However, in women who have a high risk of breast cancer, mammographic screening should be considered. There are no studies specifically evaluating DBT in this patient population. The increased breast density seen in younger women and in the hormonally altered breast of pregnant women is more likely to conceal small lesions. Therefore, this population may benefit from the ability of 3-D mammography to decrease the masking effect of dense breast tissue.
Breast Imaging of Pregnant and Lactating Women. In one study, 4 breast cancers in 3 patients were detected on high-risk screening MRI [7]. It may be helpful to wait until 3 months after cessation of breastfeeding. However, if a woman plans to nurse for a long period, or is at very high risk for breast cancer, screening breast MRI during lactation may be considered [10]. The amount of gadolinium excreted in human breast milk over the first 24 hours after IV contrast administration is <1% of the permitted dose for neonates [42]. Up-to-date recommendations with regard to breastfeeding following IV administration of gadolinium are outlined in detail in the ACR Manual on Contrast Media [33]. Therefore, although not the initial imaging tool of choice, screening breast MRI is not contraindicated during lactation and may be considered in lactating women with a high lifetime risk of breast cancer. An informed decision should be made by the mother regarding continuation of breastfeeding after the examination [3,33,42]. Sestamibi MBI There is no role for molecular breast imaging (MBI) in breast cancer screening during lactation. Mammography and DBT Screening mammography can be performed in pregnant women at high risk. Mammography is not contraindicated during pregnancy, and the dose to the fetus is negligible. The fetal radiation dose from a 4-view mammogram is <0.03 mGy. No teratogenic effects have been demonstrated below 50 mGy [43]. Screening mammography is not recommended for pregnant women who are at average or intermediate risk for breast cancer. However, in women who have a high risk of breast cancer, mammographic screening should be considered. There are no studies specifically evaluating DBT in this patient population. The increased breast density seen in younger women and in the hormonally altered breast of pregnant women is more likely to conceal small lesions. Therefore, this population may benefit from the ability of 3-D mammography to decrease the masking effect of dense breast tissue.