Yearly breast MRIs urged for 1.4 million women
New cancer guidelines advise pricey screening for those at high risk
Updated: 8:13 p.m. PT March 27, 2007
ATLANTA - Up to 1.4 million U.S. women - those with an unusually high
risk of developing breast cancer - should get annual MRIs as well as
mammograms, the American Cancer Society advises in new guidelines.
And a new medical study suggests that all women newly diagnosed with
breast cancer should get MRIs, too. The scans revealed cancers in the
opposite breast that were missed by ordinary mammograms in 3 percent
of these cancer survivors.
The study came out after the cancer society developed its guidelines,
which are the first to recommend MRI for screening women who show no
signs of cancer.
The guidelines are directed at symptomless women age 30 and older who
have a mutation in the BRCA1 or BRCA2 genes; those who were treated
for Hodgkin's disease; or those with a strong family history of the
disease, such as women with two or more close relatives who had breast
or ovarian cancer or who have a close relative who developed breast
cancer before age 50.
As many as 1.4 million women fall into the affected group, according
to an American Cancer Society estimate.
Doctors usually screen for breast cancer using mammography, an X-ray
technique that can spot dense m***** like tumors.
MRI, or magnetic resonance imaging, makes more detailed images with a
magnet and radio waves - but without radiation. MRIs are better at
showing increased or abnormal blood flow in the breast, a sign of
early cancers not visible on a mammogram. They also are better than
mammograms at detecting cancer in women with dense, non-fatty breasts.
But MRI screening is not being recommended for most women. One reason
is the test's error rate, which can lead to unnecessary biopsies.
'Very, very expensive'
Another is the high cost. While a mammogram costs roughly $100 to
$150, an MRI can cost $2,000 or more at some medical centers, experts
said.
"It's very, very expensive," said Robert Smith, the cancer society's
director of cancer screening. Many insurers cover MRI screenings, but
not all do, Smith and others said.
Insurers generally follow government guidelines, but the cancer
society guidelines could prove influential, according to experts.
The new guidelines were being announced Wednesday, the same time the
New England Journal of Medicine was releasing a national study that
suggests women who have cancer diagnosed in one breast should get an
MRI in the other.
The study, led by Dr. Constance Lehman of the University of Wa****ngton
Medical Center, looked at nearly 1,000 women recently diagnosed with
cancer in one breast but who had no detected cancer in the second
breast.
MRIs of the second breast found possible tumors in 121 of the women.
Biopsies confirmed cancer in 30 of them.
"It's a pretty striking effect," said Dr. Carl Jaffe of the National
Cancer Institute, which sponsored the study.
Mammography still has its place
But it does not suggest MRIs should replace mammograms, which spot
calcium deposits better than MRIs do, said Dr. Etta Pisano of the
University of North Carolina, one of the study's authors.
"The take-home message of our paper is not, 'Don't get mammography.'
It's 'Get MRI and mammography,"' she said.
Cancer society officials urged women to carefully choose the clinic
that does the MRI. They noted that some facilities that offer MRI lack
the expertise and equipment to do an MRI-guided biopsy, meaning the
MRI will have to be repeated elsewhere if a possible tumor is found.
Breast MRIs should be done at places that do biopsies as well, they
said.
This year, the American College of Radiology is expected to start a
voluntary accreditation program to help ensure the quality of breast
MRI testing, cancer society officials said.
For women at high risk for breast cancer, the test is definitely
worthwhile, said Courtney From Hirsch, 26, of Raleigh, N.C. She feels
that way despite MRI errors that led to two unnecessary biopsies.
Hirsch's mother was diagnosed with breast cancer in 2004, and Hirsch
and her younger sister both tested positive for the BRCA1 mutation.
They are among an estimated 22,000 women in the United States who have
tested positive in the 10 years since the test became available.
Hirsch said she also has the kind of dense breasts that are
problematic for mammograms.
She's had four breast MRIs in the past two years, two of them done as
part of biopsies, but fortunately nothing has been found.
There are downsides, she said: Lying in an MRI scanner for an hour or
more can be uncomfortable. Her family has paid $10,000 out-of-pocket
for uncovered costs from mammograms, MRIs and biopsies in the last two
years. It can be difficult to schedule "magnet time" at the busy UNC
cancer center where she gets her screenings. False positives can be
frightening, and one of the biopsies left scarring that she said was
visible at her February wedding.
"I'd rather have as many scars as I need to on my body to prevent
getting cancer," she said.
URL: http://www.msnbc.msn.com/id/17818068/
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