Women who have specific mutations in genes called BRCA1 and BRCA2 are at a much higher risk for breast cancer than the general population, and current recommendations call for monthly breast self-exams, clinical exams every six months, and mammograms every year beginning at age 25. But, since breast cancer often isn't detected until its later stages in women genetically predisposed to breast cancer, those recommendations may not be working. A new study from researchers at the Toronto-Sunnybrook Regional Caner Centre found there may be a better way to detect breast cancer in high risk women.

What the researchers wanted to know: Which breast cancer screening technique works best?

What they did: The researchers examined 236 women with either BRCA1 or BRCA2 mutations using a clinical breast examination, a mammogram, an ultrasound, and magnetic resonance imaging (MRI). On an initial visit, patients had all four types of tests on the same day. Clinical breast exams were repeated every six months and the others were given every year for a maximum of three years. The researchers kept track of all the cancers found, including those diagnosed up to a year after a patient's last screening.

What they found: Twenty-two cancers were found in the entire pool, and the MRI scan found the highest percentage of those malignancies. All together, the screening techniques in this study detected 95 percent of all cancers diagnosed (the other 5 percent were found in between screenings or during the follow-up period). MRI scans diagnosed 77 percent of all breast cancers, mammograms diagnosed 36 percent, ultrasounds found 33 percent, and clinical breast exams found 9 percent.

What it means to you: MRI screening can improve cancer detection, at least in high-risk women. With the current recommendations—breast exams and mammograms‑45 percent of breast cancers were found, whereas MRIs alone detected 77 percent of all cancers. However, MRIs are more expensive and result in more false positives, so they may not be practical for all women. .

Caveats: This study has found an increase in breast cancer detection with MRI scans. However, that doesn't necessarily mean that the scans decrease the mortality rate from breast cancer, which is the point of breast cancer detection. In addition, Ffurther studies on MRI scans need to be done to assess whether this type of screening is useful for all women or just for those at high risk.

Find out more: The National Cancer Institute has a website that describes the different types of breast cancer screening.

A U.S. News health brief described a study almost identical to this one, with similar results.

Read the article: Warner, Ellen et al. "Surveillance of BRCA1 and BRCA2 Mutation Carriers With Magnetic Resonance Imaging, Ultrasound, Mammography, and Clinical Breast Examination." Journal of the American Medical Association. Sept. 15, 2004, Vol. 292, No. 11, pp. 1317-1325.

Robinson M.E. and Offit, Kennth. "Breast MRI for Women With Hereditary Cancer Risk." Journal of the American Medical Association. Sept. 15, 2004, Vol. 292, No. 11, pp. 1368-1370.

Abstract online: http://jama.ama-assn.org/