LI Docs Back MRI Push: Cancer Society Calls Test Vital for Those at High Breast Cancer Risk but Some

Mar 29, 07:38 AM

Current Headlines: By Delthia Ricks, Newsday, Melville, N.Y.

Mar. 29--While doctors in two national studies have called for a more extensive use of MRI screening for women with higher-than-average breast cancer risk, some Long Island medical institutions say they have been been performing the scans for more than a year.

But with the American Cancer Society now recommending that women with higher breast cancer risk add magnetic resonance imaging as a screening tool, there are questions over whether enough machines exist to meet the demand. The society estimates that their recommendations could increase the number of women seeking the scans by as many as 1.4 million.

The new guidelines call for an annual mammogram and an annual MRI for women with an elevated risk for the disease. High risk is defined as having a 20 percent or higher lifetime risk of developing the disease; possessing either the BRCA 1 or 2 genetic mutations; having undergone therapeutic chest radiation for Hodgkins disease between the ages of 10 and 30, or being a carrier of rare genetic miscues, such as the Li Fraumeni mutation.

A second report appearing in today's New England Journal of Medicine found that in women who have already had cancer in one breast, an MRI should now be used to detect cancers in the other breast that might have been missed by mammography.

On Long Island, some institutions didn't need the new recommendations to start incorporating the scans into routine cancer screening. Dr. Daniel Budman, associate director of the Monter Cancer Center in Lake Success said the North Shore-Long Island Jewish Health System already recommends MRI screening for breast cancer -- and has not narrowed the population to only women at high risk.

"We've been doing this routinely for more than a year," Budman said yesterday, underscoring that Long Island's well-known disproportionally high rate of breast cancer influenced doctors at North Shore-LIJ to refer high- and average-risk women for MRI screening.

MRI costs can run from $1,000 to $2,000. The technique utilizes magnetic fields to produce detailed cross-sectional images of tissues. Doctors who wrote the American Cancer Society's new guidelines say MRI scans have a high sensitivity for detecting breast cancer in high-risk women exhibiting no telltale symptoms, such as lumps or unusual discharge.

"Data showing a benefit [of MRI] was available over a year ago," said Budman. "There were two large European studies that showed MRI was about twice as good as mammography in certain instances."

Dr. Mark Robson, a medical oncologist at Memorial Sloan-Kettering Cancer Center in Manhattan, found in a study four years ago that for high-risk women, MRI scans indeed detected the tiniest lesions, even precancerous ones. But, he also highlighted problems, such as a high rate of false positives. And some patients couldn't tolerate the narrow, tube-like structure in which scans are performed.

Yesterday, Dr. Brian J. O'Hea, director of the Carol M. Baldwin Breast Care Center at Stony Brook University Hospital, said the new guidelines could force so many women to seek the screening that there would not be enough machines to accommodate them.

"There are at least 50 mammogram machines for every one MRI machine, anywhere," O'Hea said yesterday. "Women can't even get a mammogram appointment now. ... The demand and interest in any technology can outpace our ability to provide the service. MRI screening requires sophisticated equipment and a highly specialized radiologist to read them."

Dr. Clare Bradley, chair of the cancer society's Eastern Division Mammography Task Force, said the new guidelines are important because mammography and MRI are complementary. She said screening facilities and hospitals will find a way to test those who need them most. "There are some cancers that can be picked up by both mammography and MRI, but there are some that are picked by mammography that are not picked up by MRI -- and vice versa. So that's why it is important to recommend both tests."

Q& A

A sharper tool for seeing

Do the recommendations mean that mammography is optional?

No, the American Cancer Society is recommending an annual mammogram and an annual MRI for women who are deemed at high risk.

What is having a high risk?

The cancer society is defining elevated risk as possessing genes that can predispose you to breast cancer. Women who had therapeutic chest radiation for Hodgkins disease between the ages of 10 and 30 are also deemed at high risk.

Can women who are not at high risk get an MRI?

Anyone who wants the screening should discuss it with her health care provider.

Are MRIs expensive?

Yes. They can cost between $1,000 and $2,000. Many insurers cover it but others may not. In instances when insurers refuse, doctors can intervene, encouraging underwriters to pay.

Is an MRI accurate?

Yes, but it also has a high rate of false positives. However, the technique excels in detecting cancers missed by mammography. MRI also produces a sharper image of a cancer's position and shape, an aid to its surgical removal.

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Copyright (c) 2007, Newsday, Melville, N.Y.

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