Despite recommendations from the American College of Radiology, most providers opt to delay screening in these women.
For women with the BRCA 1 and 2 mutations who are pregnant or lactating, providers vary in how they recommend the use of screening breast MRI and screening mammography.
In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Sophia O’Brien, M.D., a radiology resident from the Hospital of the University of Pennsylvania detailed the differing policies breast imagers follow for annual screening with these women.
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Currently, the American College of Radiology recommends women with these genetic mutations begin annual screening breast MRI starting between ages 25 and 30 and annual screening mammography starting at age 30.
To evaluate the utilization of and attitudes toward the use of these screening services, O’Brien surveyed Society of Breast Imaging members twice during May 2020, asking about practice information, utilization, and timing of imaging during pregnancy and lactation. She also queried members about their perceptions over false positive and false negative rates with breast MRI during lactation.
All total, 218 Society members responded, of which 19 percent reported having an institutional standardized policy for screening women with these genetic mutations during lactation. Academic-institution based providers who read more than 10 breast MRIs a day were more likely to have such a policy.
Views on how to implement the policy, however, varied. More than half of providers – 59 percent – recommended continuing screening breast MRI with a lactating patient. But, 57 percent indicated it could occur at any time while 38 percent recommended some delay. In addition, 39 percent recommended postponing until after the patient was no longer breast-feeding, and 64 percent of that group supported waiting for 1 month-to-3 months.
When it came to breast MRI in lactating women, half of respondents said they believed the exam has higher false positive and false negative rates than in women who were not lactating – 51 percent each.
Perspectives over screening mammography were a bit clearer.
“Despite ACR recommendations to consider screening mammography in pregnant high-risk women, most respondents do not perform this study,” she said.
In fact, only 32 percent of survey respondents supported continuing the exam during pregnancy with 67 percent recommended going through with the exam during lactation.
Although most providers indicated they support screening breast MRI during lactation, the variability of timing created a lack of clarity on what might be best, O’Brien said.
“Further research into the optimal timing of screening breast MRI during lactation, as well as education of breast imagers regarding ACR mammography guidelines in pregnancy, is needed,” she said.