Breast MRI in high risk patients

Abstract

In this thesis we address various indications of breast MRI, with the emphasis on the value of MRI in screening of women with high genetic risk for breast cancer, and especially in BRCA1 mutation carriers. We showed that in the era of up-to-date MRI expertise and digital mammography the screening efficacy is improved. However, the additional value of mammography over MRI is little while at the same time BRCA carriers are more sensitive the risks of low dose radiation as in mammographic screening. Based on radiation risk estimations we advise to screen BRCA1 mutation carriers annually with MRI from age 25 onwards and to postpone mammographic screening until age 40. We demonstrated that addition of MRI to mammography for screening BRCA1/2 mutation carriers of 50 years and older improved screening sensitivity by a magnitude similar to that observed in younger women. We advise to continue MRI screening in BRCA1/2 mutation carriers of 50 years and older.

Furthermore, we discuss the role of breast MRI in patients with early stage breast cancer who wish to undergo breast conserving surgery. Patients with preoperative MRI underwent significantly fewer reoperations. Preoperative MRI changed the surgical plan to more extensive surgery in a substantial part of patients.

Finally we describe that breast MRI is capable of detecting occult breast cancer in patients who present with axillary metastasis of an adenocarcinoma without a clinically or mammographically detectable breast cancer.