Q: I have high risk factors for developing breast cancer (27 percent) so I asked my doctor about Breast MRI. I was told that since I tested negative for the BRCA1 and BRCA2 genes, I don’t need it.
A: Unfortunately, the literature does not support that notion, so I must disagree with your doctor. There are many factors that go into determining a woman’s risk for developing breast cancer, and genetic composition is just one of them. The percentage of breast cancer that is genetically related is actually pretty low. In fact, The CDC estimates that only 5 to 10 percent of breast cancers are from genetic mutations, which means that more than 90 percent of women who develop it, will also test negative for genetic markers like BRCA1 or 2.
Many other factors go into the validated high-risk calculation models. They include, but are not limited to, things like family history, age when starting first menstrual period, age of starting menopause, having dense breast tissue, not being physically active, radiation therapy for medical conditions before the age of 30, and several other factors. Take a look at this basic list from the Centers for Disease Control.
The American Cancer Society guidelines for obtaining breast MRI in high risk women include women who test positive for BRCA1 or 2 genes, but also women who are above 20 percent lifetime risk as calculated by one of the standard models (like Tyrer Cuzick or BRCAPRO), even if they are BRCA negative. A more complete list is posted on its website: cancer.org.
In summary, even though you are BRCA negative, your risk factors are above 20 percent, so I think most specialists in the field would recommend a breast MRI for adjunct surveillance, even if your mammogram is normal, and especially if you have dense breast tissue.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center. You can reach him at michael.ulissey@cdirad.com.
