With the availability of tomosynthesis mammography, should women at high risk for developing breast cancer still undergo annual MRI? –Maggie Siebeneichen, BSN, BA, RN
Most practice standards, including guidelines from the National Comprehensive Cancer Network (NCCN), Version 1.2015, recommend the use of tomosynthesis as the screening tool for all women if available, but especially for women at high risk for developing breast cancer.1
At this time, annual MRI testing is only recommended for women with the following risks
- A pedigree suggestive of or a known genetic predisposition for breast cancer, starting at age 25 for hereditary breast and ovarian cancer or individualized based on earliest onset in the family;
- Reived thoracic radiation therapy between ages 10 years and 30 years;
- An adjunct to screening mammography for women whose lifetime risk of breast cancer development, as defined by models based on family history, is greater than 20%.
Tomosynthesis is preferred rather than MRI because diagnostic probability of MRI is questionable for in situ cancers. In addition, MRI has higher cost, is a more invasive procedure secondary to required contrast, and has a slow scan time.
Data from a Dartmouth-Hitchock Medical Center study on DCIS and invasive breast cancers is currently being analyzed and may answer this question better.2 (May 2015) The researchers were attempting to compare tomosynthesis vs MRI with respect to standard references, necessary re-excision rates of each modality, and evaluate patient satisfaction.
For now, tomosynthesis should be used for screening over MRI unless one or more of the above-mentioned risk factors exists. –Rosemarie Tucci, RN, MSN, AOCN
1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Breast cancer screening and diagnosis. Version 1.2015. Fort Washington, PA: National Comprehensive Cancer Network; 2015.
2. Digital breast tomosynthesis versus contrast enhanced magnetic resonance imaging (MRI) for breast cancer staging [ClinicalTrials.gov identifier NCT01060085]. ClinicalTrials.gov Web site. https://www.clinicaltrials.gov/ct2/show/NCT01060085. Last verified May 2015. Accessed August 3, 2015.