MR imaging for surveillance of women at high familial risk for breast cancer.

The adequate management of individuals who carry a high lifetime risk for breast cancer is still an unsettled issue. This holds especially true for subjects with documented or suspected germline mutation of a breast cancer susceptibility gene. These women face a lifetime risk for breast cancer of up to 80%, which is, of course, significant. Still, this means that approximately one fifth of women never develop the disease. The perceived mutilating effects of preventive mastectomy make the decision for surgical prevention difficult for most women. Secondary prevention aims at identifying familial breast cancer at the earliest possible stage. During recent years, considerable evidence has been accumulated that breast MR imaging is substantially more sensitive than mammography and breast ultrasound regarding the identification of familial breast cancer. It should be considered an integral part of a surveillance program for women at increased familial risk for breast cancer, be it with or without documented mutation of a breast cancer susceptibility gene.