Applications fall into 4 major groups:

  • 1. Screening women at increased breast cancer risk
  • 2. Assessing women with a new breast cancer diagnosis
  • 3. Problem-solving
  • 4. Breast augmentation

1. Screening women at increased breast cancer risk: Women with a very strong family history (NBOCC Category 3) under age 50 years and who are referred by a specialist qualify for annual MRI under the Medicare rebate. Important advantages of using MRI in these young women are that it does not require ionising radiation and sensitivity is not affected by dense tissue. When the risk level is uncertain, we offer risk assessment consultations and can establish the NBOCC Category. Women with other risk factors including a personal history of premenopausal breast cancer may also benefit from regular MRI particularly if they also have significant breast density.

2. Assessing women with a new breast cancer diagnosis : Of all women with breast cancer examined by MRI, about 20% have additional disease which may alter management including 3-5% found to have cancer in the other breast. Although the value of MRI as a routine staging procedure is controversial, young women with dense breasts and those with invasive lobular cancer are particularly likely to benefit. Non-calcified high-grade DCIS is also frequently encountered and the disease extent is usually well-demonstrated by MRI.

3. Problem-solving : In some cases, even after thorough clinical examination, mammography and ultrasound there are suspicious findings such that cancer cannot be excluded. In such cases the high sensitivity of breast MRI can be extremely helpful. In some cases e.g. Paget’s disease, positive axillary lymph node or nipple cytology, MRI reveals otherwise occult underlying malignancy. Breast MRI is also useful before, during, and after chemotherapy to evaluate treatment response and residual disease extent prior to surgical treatment.

4. Breast augmentation : Women with silicone breast implants who prefer not to have mammograms are particularly suitable for MRI as a cancer-screening technique and to evaluate implant integrity. Women with known or suspected PIP implants also qualify for a rebated breast MRI. Breast MRI is also valuable in small groups of women with free silicone injections or where recurrence is suspected in a TRAM flap or other autologous breast reconstruction.

Clinical indications for breast MRI referral

  • Screening of high-risk women
  • Pre-operative staging for extent of known cancer
  • Equivocal lesion on XRM, US or clinical examination
  • Complex or dense breast with equivocal mammography
  • Positive axillary node with no breast primary evident
  • Post-surgical scar versus tumour recurrence
  • Positive margins after resection ? residual disease
  • Monitoring response to neoadjuvant chemotherapy
  • Prior to accelerated partial breast irradiation (APBI)
  • Breast implants for leakage and/or cancer detection