Can Advanced Breast Cancer Risk Help Identify Women Who May Benefit from MRI Screening?
A new Breast Cancer Surveillance Consortium (BCSC) study examines breast MRI and mammography screening outcomes based on women's risk of developing advanced breast cancer.
A new study from the Breast Cancer Surveillance Consortium (BCSC), published November 6, 2026, in JAMA Network Open, suggests that a woman's risk of developing advanced breast cancer may help inform decisions about breast MRI screening.
Breast MRI is more sensitive than mammography for detecting breast cancer, but it also leads to more false-positive findings, which can result in unnecessary biopsies. An important question is whether MRI screening can reduce the number of women diagnosed with advanced breast cancer, which is more difficult to treat and associated with worse outcomes.
What Did the Researchers Study?
Researchers analyzed data from 105,532 women ages 40 to 74 who underwent 172,865 breast screening examinations at BCSC facilities between 2005 and 2021. The study compared screening outcomes among women receiving breast MRI, with or without mammography, and women receiving mammography alone. Researchers used the BCSC advanced breast cancer risk model to classify women into lower- and higher-risk groups based on their predicted risk of developing advanced breast cancer over six years. The researchers examined rates of early-stage and advanced breast cancer, as well as false-positive screening results, and investigated whether outcomes differed between a woman's first MRI and subsequent MRI examinations.
What Did the Study Find?
Women at higher risk of advanced breast cancer had higher rates of advanced cancer following mammography screening. Among women receiving mammography alone, those with intermediate to high advanced cancer risk had approximately twice the rate of advanced cancer compared with women at low to average risk (0.6 vs. 0.3 per 1,000 examinations).
MRI detected more early-stage breast cancers but also resulted in more false-positive findings. Compared with mammography alone, MRI screening was associated with substantially higher rates of early-stage invasive breast cancer detection across both risk groups. However, MRI was also associated with approximately five to six times as many false-positive biopsy recommendations compared to mammography alone.
Advanced cancer rates were not significantly lower with MRI than with mammography alone. The study did not find evidence that the difference in advanced cancer rates between MRI and mammography varied significantly by advanced cancer risk group.
Women undergoing repeat MRI screening had lower rates of advanced cancer than those undergoing their first MRI. Advanced cancer rates were 0.4 per 1,000 subsequent MRI examinations compared with 2.0 per 1,000 first MRI examinations. This finding suggests that screening history may be important when evaluating MRI outcomes, although the observational study cannot establish that repeated MRI screening caused the lower rates.
What Do These Findings Mean for Women?
These findings highlight the importance of considering a woman's individual breast cancer risk when making screening decisions. Women at elevated risk of advanced breast cancer may benefit from discussing supplemental MRI screening with their healthcare provider. However, the potential benefits of detecting additional early-stage cancers must be weighed against the increased likelihood of false-positive results and unnecessary biopsies. The study also underscores the need for additional research to determine whether the benefit of MRI varies according to elevated advanced breast cancer risk and breast density.
The bottom line: Personalized breast cancer screening should consider not only a woman's likelihood of developing breast cancer, but also her risk of developing advanced disease and the potential benefits and harms of different screening strategies.
Kerlikowske K, Abraham L, Zhu W, et al. Magnetic Resonance Imaging and Mammography Outcomes by Advanced Breast Cancer Risk. JAMA Netw Open. 2026;9(11):e2642398. doi:10.1001/jamanetworkopen.2026.42398 [link]
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