Which risk model to use? Clinical implications of the ACS MRI screening guidelines

Cancer Epidemiol Biomarkers Prev. 2013 Jan;22(1):146-9. doi: 10.1158/1055-9965.EPI-12-0570. Epub 2012 Oct 23.


The American Cancer Society (ACS) guidelines define the appropriate use of MRI as an adjunct to mammography for breast cancer screening. Three risk assessment models are recommended to determine if women are at sufficient risk to warrant the use of this expensive screening tool, however, the real-world application of these models has not been explored. We sought to understand how these models behave in a community setting for women undergoing mammography screening. We conducted a retrospective analysis of 5,894 women, who received mammography screening at a community hospital and assessed their eligibility for MRI according to the ACS guidelines. Of the 5,894 women, 342 (5.8%) were eligible for MRI, but we found significant differences in the number of eligible women identified by each model. Our results indicate that these models identify very different populations, implying that the ACS guidelines deserve further development and consideration.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • American Cancer Society
  • Breast Neoplasms / diagnosis*
  • Cohort Studies
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / standards*
  • Female
  • Genetic Predisposition to Disease
  • Guideline Adherence
  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging / standards*
  • Mammography / methods
  • Mammography / standards*
  • Middle Aged
  • Models, Statistical*
  • Needs Assessment
  • Patient Selection
  • Practice Guidelines as Topic*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Management
  • United States