April 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Abbreviated MRI in High-Risk Breast Screening

Breast cancer (BC) is the most common cancer among U.S women and its incidence increases with age. BC screening is crucial for early cancer detection. Mammography has long been the backbone with a large body of evidence pointing out a reduction of BC-specific mortality up to 30%. Despite the overall high performance of digital mammography screening, strong indicators have revealed that mammography, suffering from tissue superimposition, gives rise to false positive and negative findings. Indeed, mammography’s sensitivity drops significantly when screening women at increased BC risk and in those with dense breasts.

The American College of Radiology (ACR) recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI (BR-MRI). This is the most sensitive tool for detecting breast cancer. It is able to detect lesions that are occult with other screening modalities. In 2007, the American Cancer Society (ACS) put forth recommendations for patients at high risk who should consider having a screening BR-MRI. In 2018, recommendations for screening BR-MRI were expanded by the ACR to include women with both a personal history of breast cancer and dense breast tissue, and women who were diagnosed with breast cancer before the age of 50. The ACR further recommends that patients who have atypia on a biopsy and additional risk factors should consider a screening breast MRI.

There are inherent drawbacks when using full protocol breast MRI. These include the time required for a breast MRI to be performed and the high cost of a breast MRI to the health care system. Abbreviated breast-MRI (AB-MRI), with less scanner time and cost, has opened up a window that takes advantage of detecting cancers that have certain aggressive biological and vascular characteristics at earlier stages.

AB-MRI is not only effective for screening among high-risk women but also useful for evaluating “pure” ductal carcinoma in situ (DCIS). AB-MRI demonstrates a higher cancer detection rate compared with mammography only and may provide a supplemental screening method to detect breast cancers in patients with varying risk factors.

Journal of breast imaging. 2023, 5 (3); 318-328
JACR. 2023, 20 (9): 902-914

Erica Cross, PA


Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.