Q: I read that the American Cancer Society (ACS) is now recommending breast MRIs as well as mammograms for women at high risk for breast cancer. How do I know if I need a MRI?

Ask Our Experts About Breast MRI

About Our Experts

Gregory R. Harper, M.D., is the medical director of Breast Health Services at Lehigh Valley Health Network.

Kenneth Harris, M.D., is the director of breast imaging of Breast Health Services at Lehigh Valley Health Network.

• I read that the American Cancer Society (ACS) is now recommending breast MRIs as well as mammograms for women at high risk for breast cancer. How do I know if I need a MRI?
• If a woman has been recently diagnosed with breast cancer after a mammogram, why would she need a MRI?
• So why not just do MRIs on everyone?
• Will insurance pay for a MRI?
• Do MRIs have a high rate of false positives?
• Are there other uses for breast MRI?

Q: I read that the American Cancer Society (ACS) is now recommending breast MRIs as well as mammograms for women at high risk for breast cancer. How do I know if I need a MRI?

A: An annual mammogram remains the best screening method for most women, but if you are at high risk, or if you have been recently diagnosed with breast cancer, MRI is an effective addition to your evaluation.

If your lifetime risk for developing breast cancer is more than 20 percent, the ACS recommends an annual MRI. If genetic testing determines you have certain mutations (BRCA), you also are a candidate. If your family has a high rate of ovarian and breast cancer, you should have annual MRIs, even if genetic testing is negative. If you had radiation to your chest area between ages 10-30 for treatment of other disorders, such as Hodgkin's Lymphoma, you are a candidate. Also, if you have other rare high-risk syndromes (Cowden or Li-Fraumeni) you should have annual MRIs. Our Cancer Risk Assessment Program can help you with risk assessment using models that are based on the health history of you and your family.

When annual screening is recommended in these situations, we will advise you to stagger the imaging so you will have mammography in one month and the MRI six months later. You would then have a screening every six months.

As of now, there is not sufficient evidence to recommend a yearly MRI if you have a personal history of breast cancer or dense breast tissue, as long as your risk for developing cancer is less than 20 percent. If you have breast cancer, talk to your cancer physician to determine if you are a candidate for MRI evaluation.

Q: If a woman has been recently diagnosed with breast cancer after a mammogram, why would she need a MRI?

A: MRI is useful in determining the extent of disease in a breast where cancer is suspected or diagnosed. In addition, in a recently published study, MRIs found cancer (undetected by a mammogram) in the opposite breast of 3 percent of women already diagnosed with breast cancer. Detecting cancer in the other breast enables women to have definitive treatment of both cancers at the same time. In addition, a woman who knows the opposite breast is cancer-free by MRI can be reassured that a preventive mastectomy for the healthy breast is not necessary.

Q: So why not just do MRIs on everyone?

A: MRI evaluation is useful in newly diagnosed breast cancer to determine the extent of disease in the involved breast and evaluate for the presence of disease in the opposite breast. MRI is useful to screen selected women at high risk for developing breast cancer. MRI is not useful for screening women at average risk for breast cancer, or women with mostly fatty tissue in the breast. In addition, insurance companies will not pay for screening MRIs unless specifically indicated.

Q: Will insurance pay for a MRI?

A: A MRI costs 10 times as much as a mammogram, but most insurance companies will pay for it when your doctor shows it is necessary for the reasons listed.

Q: Do MRIs have a high rate of false positives?

A: MRIs can have a high rate of false positives. However, in centers like Breast Health Services at Lehigh Valley Hospital, where radiologists are experienced in reading MRI studies, false positives are fewer. If your doctor recommends a breast MRI, it is important to have it done by an experienced, on-site professional staff that can correlate your physical examination, your digital mammogram, and perhaps an ultrasound with your MRI.

Q: Are there other uses for breast MRI?

A: Yes. For the past few years at Lehigh Health Networkl, we have been using breast MRI for staging newly diagnosed cancer to see if it has spread within the breast or to the opposite breast, and to determine the extent of cancer within the breast. MRIs also are helpful in looking for ruptured silicone breast implants, differentiating scar tissue from recurrent cancer or determining if chemotherapy is working. We also use MRIs in difficult situations when mammography and/or ultrasound does not explain the clinical findings.

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