Primary Studies on Breast MRI Screening of High-Risk Women

In this chapter, we first provide an overview of the general context given by screening mammography in the general female population, including the hot debate about its harm-to-benefit balance and the wide range of estimated overdiagnosis, associated with overtreatment. In particular, the limitations of the principle one size fits all underlying population-based screening programs is discussed, with the perspectives for more personalized approaches, based on risk stratification. We then describe the main results obtained by intra-individual prospective studies comparing breast magnetic resonance (MRI) with clinical breast examination and conventional imaging, i.e., mammography and ultrasound (US), for screening women at high risk of breast (BRCA mutation carriers and women with strong family history of breast/ovarian cancers). In particular, we distinguish the initial studies, published from 2000 to 2005, on whose results the American Cancer Society based its 2007 guidelines in favor of MRI as an adjunct to mammography for high-risk screening, from the subsequent studies published between 2007 and 2015. The latter expanded the existing body of knowledge showing not only that MRI is more accurate than mammography and/or US for high-risk screening but also that, when MRI is performed, the added value of conventional imaging is low, leading to the reverted principle of mammography as an adjunct to MRI, only if necessary. In addition, the ten key points suggested in 2010 by the multidisciplinary panel of EUSOMA for MRI screening of high-risk women are here reported. Finally, some relevant retrospective studies specifically focusing on the contribution of mammography and on MRI false-negative cases in high-risk screening are considered.