Looking for breast cancer with MRI's

A patient asked me the other day about whether MRI scans could be used instead of mammograms, as a more high-tech way to screen for breast cancer. By happenstance, there is a major review article on breast cancer imaging and treatment in the latest issue of the Journal of the American College of Surgeons.
Here are the consensus recommendations of their blue-ribbon panel of experts:
Mammograms, whether standard or digital, are still the recommended method for screening for breast cancer in the general population. If you have an “average” level of breast cancer risk, start getting them at age 40.
The use of MRI as a screening tool is supported by a number of clinical trials, but only for those patients who are at high risk of breast cancer. Appropriate candidates for MRI include:
– women who have a breast cancer risk greater than 20-25%, based on predictive models;
– women who are positive for the BRCA1 or BRCA2 gene, or who are first degree relatives of someone who is positive;
– individuals with previous radiation therapy to the chest between ages 10 – 30;
– women with certain uncommon syndromes with an increased risk of breast cancer.
MRI is also useful for evaluating a newly diagnosed breast cancer, evaluating the opposite breast, for planning treatment or evaluating response to treatment.