Breast cancer and non-malignant breast data: Quantification by FPT - Signal Processing in MRS with Biomedical Applications - page 304

upon family history and use of population registries. However, for persons
born outside the country and/or who have a “limited family structure” (LFS)
[360, 361] this high risk may not be adequately detected. This LFS may pos
sibly be related to trends toward smaller families, as well as lack of paternal
aunts and premature mortality. The impact of missing family links has been
shown to have a particularly dramatic impact when the family risk for disease
is very high [362]. These considerations further complicate efforts to define
high risk and underscore the need for maximal diagnostic accuracy and wide
applicability of breast cancer screening methods.
There has been increasing interest in other modalities besides mammogra
phy for early breast cancer detection and screening, particularly for younger
women at potentially high risk [363]. Ultrasound combined with mammog
raphy improves sensitivity for detecting breast cancer; however, this combi
nation also substantially increases the false positive rate [353]. Thus, the
usefulness of wholebreast ultrasonography has not been established for rou
tine screening [355].
10.2 In vivo MR-based modalities for breast cancer di-
agnostics and clinical assessment
10.2.1 Magnetic resonance imaging applied to detection of
breast cancer
Magnetic resonance imaging is gaining acceptance for screening women at in
creased risk for breast cancer. The American Cancer Society now recommends
MRI for women with an estimated lifetime breast cancer risk at or above 20
to 25% [354]. One advantage of MRbased diagnostics is the lack of exposure
to ionizing radiation to the breast, which is a radiosensitive tissue. This is im
portant in view of the heightened radiosensitivity for women with genetic risk
for breast cancer, i.e., with BRCA germline mutations, LiFraumeni syndrome
(p53 tumor suppressor gene mutations), as well as those who are heterozygous
for ataxiatelangiectasia [364, 365]. This concern about exposure to ionizing
radiation is also based upon the need to begin screening women with genetic
risk at a younger age and with increased frequency.
There is consistent evidence that MRI is more sensitive than mammography
for detecting breast cancer among women with an increased risk [354, 366].
Breast MRI is valuable for identifying malignancy in dense breasts, in which
cancers, unless calcified, are di cult to perceive using mammography [367,
368]. Dynamic contrast enhanced (DCE) MRI can detect a typical pattern of
tumor microvasculature characterized by rapid washin and washout [369].
Breast MRI is also considered superior to mammography for identifying mul
tifocal or multicentric cancers, as well as tumor recurrence and response to