Guidelines and Recommendations on High-Risk Breast Cancer Screening All Over the World: Agreements and Differences

Abstract

Many countries have considered the evidence for screening with breast magnetic resonance imaging (MRI) and mammography and have made recommendations to offer this to women who are proven to be carriers of a BRCA deleterious mutation or are at 50% risk of being mutation carriers. There are slight variations in the recommendations issued in different countries, in relation to the lifetime risk of developing breast cancer which allows eligibility for the screening and to the age at which the screening should be started and ended. Most countries recommend an annual MRI examination with many of them adding this to mammography. Most guidelines suggest that the two examinations are carried out simultaneously; only an Austrian guideline suggests that the two examinations can be also done 6 months apart. No country offers annual ultrasound with mammography unless there is a contraindication to MRI. In high-risk women, MRI screening is generally only offered in those countries that offer mammography screening to their average-risk female population. It was postulated that it is only those countries where there is a high healthcare expenditure (i.e., where there is a willingness to pay for expensive healthcare interventions) coupled with a high ratio of MRI scanners per head of population that would offer MRI screening, but this was not found to be the case. This chapter summarizes the surveillance offered in each country and highlights the similarities and differences.