A 39-year-old woman with BRCA1 mutation undergoes annual surveillance. Her heterogeneous fibroglandular breasts are classified as ACR density category C. Which supplemental screening modality has the highest sensitivity for cancer detection in this context?
- A Digital breast tomosynthesis (DBT) alone
- B Whole-breast ultrasound
- C Breast MRI ✓
- D Contrast-enhanced mammography (CEM)
Correct answer: C. Breast MRI
Explanation
Breast MRI has the highest sensitivity (approximately 71–100%) for cancer detection in high-risk women with dense breasts, and is recommended annually for BRCA mutation carriers. MRI detects cancers invisible on mammography and ultrasound due to its ability to show tumour vascularity. DBT reduces recall rate but does not add significant sensitivity in very high-risk dense breasts. Whole-breast ultrasound is a supplemental option when MRI is unavailable but has lower sensitivity. CEM provides functional information similar to MRI but is a second-line supplemental tool.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.