Breast MRI

What is breast magnetic resonance imaging (MRI)?

Breast MRI uses magnetic fields to create an image of the breast.

Breast MRI is used in breast cancer screening for women at higher risk. It’s not recommended in breast cancer screening for women at average risk.

Breast MRI is also used in breast cancer diagnosis and staging. For example, some people have hard-to-find breast cancers. They may have cancer in the axillary lymph nodes (the lymph nodes in the underarm area) or metastases (spread to other parts of the body) at diagnosis. In these cases, an MRI may help find the original tumor in the breast.

Breast MRI vs. mammography

Compared to mammography, screening with breast MRI has some drawbacks [80-84]:

• Breast MRI is more invasive than mammography because a contrast agent (gadolinium) is given through an IV into a vein before the procedure. In rare cases, some people have a reaction to gadolinium.
• Gadolinium may build up in the brain over time in people who get MRIs on a regular basis, such as women at high risk of breast cancer who get regular breast MRI screening. Whether or not this build up has health risks is under study.
• Breast MRI has more false positive results than mammography. A false positive result suggests a possible breast cancer, even though breast cancer isn’t present. The suspicious area must be checked with follow-up tests, often a biopsy, to be sure there’s no breast cancer.
• Breast MRI is also likely to cause over-diagnosis. For example, when it finds small, invasive breast cancers that would have never caused symptoms or problems if left untreated.
• Some MRI centers don’t have the special magnets needed to do an MRI of the breast or don’t have radiologists specially trained to read breast MRIs.
• Breast MRI is expensive and isn’t always covered by insurance.

The following is an interactive model of what a breast MRI may show.

Breast MRI and breast cancer screening for women at higher risk

Compared to mammography alone, mammography plus breast MRI can increase detection of breast cancer in some women at higher risk of breast cancer [68-71].

The National Comprehensive Cancer Network (NCCN) recommends yearly screening with mammography plus breast MRI for some women at higher risk of breast cancer, including those with [3,66]:

• A BRCA1 or BRCA2 inherited gene mutation
• A first-degree relative (mother, sister, daughter) with a BRCA1/2 inherited gene mutation, but have not been tested for BRCA1/2 gene mutations themselves
• Li-Fraumeni syndrome or Cowden/PTEN syndrome (and first-degree relatives)
• A PALB2, PTEN, STK11 or TP53 inherited gene mutation
• Radiation treatment to the chest area between ages 10-30
• A greater than 20% lifetime risk of invasive breast cancer based mainly on family history (Estimate your lifetime risk or learn more about risk.)

The NCCN recommends some women at higher risk of breast cancer consider breast MRI as part of breast cancer screening, including those with [3,66]:

• Lobular carcinoma in situ (LCIS) who also have a 20% or greater lifetime risk of invasive breast cancer
• Atypical hyperplasia who also have a 20% or greater lifetime risk of invasive breast cancer
• An ATM, BARD1, CDH1, CHEK2, NF1, RAD51C or RAD51D inherited gene mutation

Both the NCCN and the American Cancer Society (ACS) recommend women at higher risk of breast cancer begin screening at an earlier age than women at average risk [2-3]. Figure 3.5 and Figure 3.6 outline their guidelines.

Women at higher risk of breast cancer who are recommended to have breast MRI as part of their breast cancer screening, but cannot have one for medical reasons, may consider contrast-enhanced mammography or molecular breast imaging [3]. If these are not available, whole breast ultrasound may be considered [3].

Talk with your health care provider about breast cancer screening. Together, you can make a screening plan that’s right for you.

For a summary of research studies on breast cancer screening with breast MRI plus mammography and mammography alone for women at high risk of breast cancer, visit the Breast Cancer Research Studies section.

Timing of breast MRI screening

If you’re at high risk of breast cancer and getting a mammogram and a breast MRI every year for screening, your health care provider may stagger the tests, so you get one test every 6 months.

Insurance coverage

Insurance coverage for breast MRI screening varies. When you schedule your screening appointment, make sure it’s covered by your insurance. Your health care provider can help check your coverage or you can contact your insurance company.

Learn more about health insurance.

Find information on what to do if an insurance claim is denied.

Breast MRI- topics under study

Researchers are studying whether breast MRI may be helpful, including other breast cancer screening in certain women. Some of these topics are discussed below.

Breast MRI for screening women with a personal history of breast cancer

Researchers are studying adding breast MRI to mammography in screening for new breast cancers in women with a personal history of breast cancer.

In women who’ve had cancer in one breast, mammography plus breast MRI can find a few more breast cancers (in the treated breast (in those who had a lumpectomy) and in the opposite breast) than mammography alone [85-88].

However, it’s not clear that adding breast MRI leads to improved survival for women who’ve had breast cancer [88-90]. It also increases false positive results and biopsy rates [85-88]. So, it’s not routinely recommended.

Breast MRI appears more likely to offer a screening benefit to some younger breast cancer survivors and breast cancers survivors who have dense breasts [90]. These topics are under study.

Learn about breast cancer screening for new cancers in women who’ve had breast cancer.

Breast MRI for screening women with dense breast tissue

Mammography plus breast MRI is under study for screening in women with dense breast tissue [12,85,91-93].

In women with dense breasts, breast MRI plus mammography may find a few more breast cancers than mammography alone [12,91-92]. However, adding breast MRI increases false positive results biopsy rates, and it’s unclear whether it improves breast cancer outcomes [12,91].

Both the National Comprehensive Cancer Network and the American Cancer Society state there’s not enough evidence to make a recommendation for or against MRI screening for women who have dense breasts [2-3].

Learn more about breast density on a mammogram.

Learn more about breast density and breast cancer risk.

Breast MRI for surgical planning in people diagnosed with breast cancer

Although controversial, breast MRI is sometimes used to help guide the choice between a mastectomy and a lumpectomy.

Using breast MRI in this way is controversial because it’s not clear if the small masses found on an MRI would be more effectively treated with a mastectomy or with a lumpectomy plus radiation therapy [67,162-163]. So, having a breast MRI before surgery may lead to more mastectomies with no added treatment benefit.

Learn more about the use of breast MRI pre-operatively to make surgery decisions.

Updated 03/17/25

This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.