[High-risk screening using magnetic resonance imaging]

Specialized breast cancer early detection programs with magnetic resonance imaging (MRI) in high-risk patients are by now well established in several countries. In Germany, such a program has been running as part of routine care since 2005.

This review article will summarize current developments in high-risk screening with MRI.

Experiences with the high-risk screening program in Germany over now more than 10 years as well as a review of the current literature will form the basis for this article.

The MRI of the breast is by far the most sensitive imaging modality for the detection of breast cancer and represents the back bone of high-risk screening. More than 90% of cancers detected at high-risk screening are visible on the MRI and more than 30% of cancers are detected primarily by MRI alone. However, a prerequisite for effective screening with MRI is a sufficiently high breast cancer incidence in the screened population. This is demonstrated by the fact that the positive predictive value of screening with MRI in women without a BRCA1/2 mutation in the age group between 30 and 39 years is unacceptably low with 2.9%.

In high-risk screening, MRI is the primary imaging tool with mammography and/or ultrasound added as adjunct if necessary. In women with a strong family history of breast cancer but no proven pathogenic mutation in one of the known risk genes in the index patient in the family, the high-risk screening should not routinely start at age 30, but should be postponed until the 10-year breast cancer risk passes a threshold of 5%.