Cancer Treatment Today

Atypical lesions and lobular carcinoma in situ (LCIS) are associated with an increased risk of breast malignancy, but how MRI surveillacne impacts the risk is controversial. Schwartz et al conluded:”Large, prospective studies would be needed to determine whether breast cancer outcomes differ between patients undergoing conventional breast screening and those undergoing conventional breast screening plus breast MRI surveillance.” However, guidelines support this trategy. The American Cancer Society (ACS) recommends that all high-risk women those with a greater than 20% lifetime risk of breast cancer have a breast MRI and a mammogram every year. For most women, these combined screenings should start at age 30 and continue as long as the woman is in good health. The American Cancer Society also recommends that women at moderately increased risk of breast cancer those with a 15-20% lifetime risk talk with their doctors about the possibility of adding breast MRI screening to their yearly mammogram. According to ACS guidelines, this includes women who: find out they have a lifetime risk of breast cancer of 15-20%, according to risk assessment tools based mainly on family history have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), or abnormal breast cell changes such as atypical ductal hyperplasia or atypical lobular hyperplasia have extremely dense breasts or unevenly dense breasts when viewed by mammograms. The situation in this case si that lobular atypia does increase risk and MRI surveillance every 6 months is appropriate according to this guideline. CAD is standard in the assessment of screening and surveillance MRI studies.

King TA, Muhsen S, Patil S, et al. Is there a role for routine screening MRI in women with LCIS?. Breast Cancer Res Treat. 2013;142(2):445-453. doi:10.1007/s10549-013-2725-5

American Cancer Society: https://www.breastcancer.org/symptoms/testing/types/mri/screening, Accessed July 3 2020.