Development and Implementation of an Algorithm to Guide MRI Screening in Patients With a Personal History of Treated Breast Cancer

Published:October 17, 2020DOI:



      Limited data exist to guide appropriate use of magnetic resonance imaging (MRI) screening in women with a personal history of breast cancer. We developed an algorithm to inform the use of MRI screening in patients with a personal history, implemented it, and evaluated initial implementation at our community and academic practice sites.

      Patients and Methods

      A multidisciplinary committee of providers developed the initial algorithm on the basis of available literature and consensus. To evaluate projected MRI utilization based on the initial algorithm and inform algorithm revision, charts of patients < 80 years of age diagnosed and treated in 2010 with stage 0-III breast cancer (n = 236) were reviewed. The revised algorithm was implemented into the electronic medical record (September 2013). Thirteen months after implementation (2014-2015), chart review of patients with a personal history of breast cancer who underwent screening MRI was performed to assess algorithm adherence.


      Before algorithm development, 9% (20/236) of patients received MRI screening (6 genetic mutation/family history, 4 occult primary, 8 young age/breast density, 2 unknown). Use of MRI screening was projected to increase to 25% with algorithm implementation. In postimplementation review, we identified 183 patients with a personal history of breast cancer who underwent screening MRI, with 94% algorithm adherence.


      We successfully developed and implemented an algorithm to guide MRI screening in patients with a personal breast cancer history. Clinicians can use this algorithm to guide patient discussions regarding the utility of MRI screening. Further prospective study, including cancer detection rates, biopsy rate, and mortality, are necessary to confirm the algorithm’s usefulness.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Saslow D.
        • Boetes C.
        • Burke W.
        • et al.
        American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography.
        CA Cancer J Clin. 2007; 57: 75-89
        • Brennan S.
        • Liberman L.
        • Dershaw D.D.
        • et al.
        Breast MRI screening of women with a personal history of breast cancer.
        AJR Am J Roentgenol. 2010; 195: 510-516
        • Price J.
        • Chen S.W.
        Screening for breast cancer with MRI: recent experience from the Australian Capital Territory.
        J Med Imaging Radiat Oncol. 2009; 53: 69-80
        • Elmore L.
        • Margenthaler J.A.
        Breast MRI surveillance in women with prior curative-intent therapy for breast cancer.
        J Surg Res. 2010; 163: 58-62
        • Lehman C.D.
        • Lee J.M.
        • DeMartini W.B.
        • et al.
        Screening MRI in women with a personal history of breast cancer.
        J Natl Cancer Inst. 2016; 108: djv349
        • Schacht D.V.
        • Yamaguchi K.
        • Lai J.
        • et al.
        Importance of a personal history of breast cancer as a risk factor for the development of subsequent breast cancer: results from screening breast MRI.
        AJR Am J Roentgenol. 2014; 202: 289-292
        • Niell B.L.
        • Gavenonis S.C.
        • Motazedi T.
        • et al.
        Auditing a breast MRI practice: performance measures for screening and diagnostic breast MRI.
        J Am Coll Radiol. 2014; 11: 883-889
        • Strigel R.M.
        • Rollenhagen J.
        • Burnside E.S.
        • et al.
        Screening breast MRI outcomes in routine clinical practice: comparison to BI-RADS benchmarks.
        Acad Radiol. 2017; 24: 411-417
        • National Comprehensive Cancer Network (NCCN)
        NCCN clinical practice guidelines in oncology: breast cancer, version 2.2019.
        (Available at:)
        • Bouchardy C.
        • Benhamou S.
        • Fioretta G.
        • et al.
        Risk of second breast cancer according to estrogen receptor status and family history.
        Breast Cancer Res Treat. 2011; 127: 233-241
        • Khan S.A.
        Contralateral prophylactic mastectomy: what do we know and what do our patients know?.
        J Clin Oncol. 2011; 29: 2132-2135
        • Kurian A.W.
        • McClure L.A.
        • John E.M.
        • et al.
        Second primary breast cancer occurrence according to hormone receptor status.
        J Natl Cancer Inst. 2009; 101: 1058-1065
        • Fowble B.
        • Hanlon A.
        • Freedman G.
        • et al.
        Second cancers after conservative surgery and radiation for stages I-II breast cancer: identifying a subset of women at increased risk.
        Int J Radiat Oncol Biol Phys. 2001; 51: 679-690
        • Punglia R.S.
        • Hassett M.J.
        Using lifetime risk estimates to recommend magnetic resonance imaging screening for breast cancer survivors.
        J Clin Oncol. 2010; 28: 4108-4110
        • Zakhireh J.
        • Fowble B.
        • Esserman L.J.
        Application of screening principles to the reconstructed breast.
        J Clin Oncol. 2010; 28: 173-180
        • DeMartini W.B.
        • Ichikawa L.
        • Yankaskas B.C.
        • et al.
        Breast MRI in community practice: equipment and imaging techniques at facilities in the Breast Cancer Surveillance Consortium.
        J Am Coll Radiol. 2010; 7: 878-884
        • Elmore L.
        • Margenthaler J.A.
        Use of breast MRI surveillance in women at high risk for breast cancer: a single-institutional experience.
        Ann Surg Oncol. 2010; 17: 263-267
        • Stout N.K.
        • Nekhlyudov L.
        Early uptake of breast magnetic resonance imaging in a community-based medical practice, 2000-2004.
        J Womens Health (Larchmt). 2011; 20: 631-634
        • Monticciolo D.L.
        • Newell M.S.
        • Moy L.
        • et al.
        Breast cancer screening in women at higher-than-average risk: recommendations from the ACR.
        J Am Coll Radiol. 2018; 15: 408-415
        • Yang T.J.
        • Yang Q.
        • Haffty B.G.
        • et al.
        Prognosis for mammographically occult, early-stage breast cancer patients treated with breast-conservation therapy.
        Int J Radiat Oncol Biol Phys. 2010; 76: 79-84
        • Boyd N.F.
        • Guo H.
        • Martin L.J.
        • et al.
        Mammographic density and the risk and detection of breast cancer.
        N Engl J Med. 2007; 356: 227-236