When do you recommend a breast MRI for breast cancer surveillance?

MRI is a routine part of the work up (this would not be screening) for women presenting with axilary nodal disease and occult primary. In the era of MRI the incidence of so called occult primary has gone down becuase of higher sensitivity of MRI

As far screening is concerned, it is approved for high risk populations which is defined by a life time risk of breast cancer of 20% or greater. Women would qualify based on familal breast cancer genes or mantle field RT at young age. For others, it is individual case by case discussion.

Breast MRI screening is recommended for women who have a lifetime breast cancer risk of 20% or higher, as well BRCA and other germline mutations carriers, such as p53, ATM, PLAB2. The NCCN guidelines have recommendations by gene as well as start age.