In some mutation carriers, some referring providers use mammography or DBT beginning at 40 years of age if patients undergo annual MRI [80]. Women who underwent thoracic or upper abdominal radiation therapy at an early age (<30 years) should begin screening mammography 8 years after radiation therapy but not before 25 years of age [3]. Mammography With IV Contrast Data are limited regarding the use of mammography with IV contrast for breast cancer screening in high-risk women. To date, published studies have predominantly included women with dense breasts and other risk factors resulting in intermediate or high-risk profiles. Compared to mammography alone, mammography with IV contrast increases sensitivity and cancer detection (incremental CDR = 6.6-13 per 1,000) in women at elevated risk [57-60]. Mammography with IV contrast may be useful in high-risk women as an alternative to MRI. MRI Breast Without and With IV Contrast MRI has a higher CDR than mammography alone, DBT, or mammography/DBT combined with US [61-64]. In high-risk women, supplemental screening MRI combined with mammography yields a 91% to 98% sensitivity, although the reported specificity of MRI is typically lower than mammography [40,81]. The incremental CDR of MRI in elevated-risk women ranges from 8 to 29 per 1,000 women, with higher CDR (26 per 1,000) in BRCA mutation carriers [61-63,65,66]. 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 a greater frequency of image-guided biopsies than mammography (11.8 versus 2.4%) [63]. Since 2007, the American Cancer Society has recommended annual breast MRI for breast cancer screening in high- risk women [4].
Female Breast Cancer Screening. In some mutation carriers, some referring providers use mammography or DBT beginning at 40 years of age if patients undergo annual MRI [80]. Women who underwent thoracic or upper abdominal radiation therapy at an early age (<30 years) should begin screening mammography 8 years after radiation therapy but not before 25 years of age [3]. Mammography With IV Contrast Data are limited regarding the use of mammography with IV contrast for breast cancer screening in high-risk women. To date, published studies have predominantly included women with dense breasts and other risk factors resulting in intermediate or high-risk profiles. Compared to mammography alone, mammography with IV contrast increases sensitivity and cancer detection (incremental CDR = 6.6-13 per 1,000) in women at elevated risk [57-60]. Mammography with IV contrast may be useful in high-risk women as an alternative to MRI. MRI Breast Without and With IV Contrast MRI has a higher CDR than mammography alone, DBT, or mammography/DBT combined with US [61-64]. In high-risk women, supplemental screening MRI combined with mammography yields a 91% to 98% sensitivity, although the reported specificity of MRI is typically lower than mammography [40,81]. The incremental CDR of MRI in elevated-risk women ranges from 8 to 29 per 1,000 women, with higher CDR (26 per 1,000) in BRCA mutation carriers [61-63,65,66]. 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 a greater frequency of image-guided biopsies than mammography (11.8 versus 2.4%) [63]. Since 2007, the American Cancer Society has recommended annual breast MRI for breast cancer screening in high- risk women [4].