Reports Urge Wider Use of MRI for Breast Cancer

Mar 29, 01:51 PM

Current Headlines: By Denise Grady

Two reports published Wednesday in the United States call for greatly expanded use of magnetic resonance imaging for women who have breast cancer or who are at high risk of developing the disease.

The recommendations on the scans, whose technology is commonly referred to as MRI, do not apply to most healthy women, who have only an average risk of developing breast cancer. But even so, the new guidelines could add a million or more women in the United States a year to those who need magnetic resonance imaging of the breasts - a demand that radiologists are not yet equipped to meet, researchers say.

Breast MRI requires special equipment and software and trained radiologists to read the results. A scan costs $1,000 to $2,000 in the United States, sometimes more, which is 10 times the cost of mammography. So a million more scans a year could cost at least $1 billion.

The scans are sometimes covered in the United States by insurance and Medicare, sometimes not, depending on the reason for the test.

One of the reports released Wednesday is a set of new U.S. guidelines for using MRI in women at high risk for breast cancer. The other is a study in The New England Journal of Medicine showing that in women who have newly diagnosed cancer in one breast, MRI can find tumors in the other breast that mammograms miss.

MRI has drawbacks. It is so sensitive that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false- positive findings may be acceptable. But the risk of needless biopsies and additional scans is not generally considered reasonable for women with just an average risk of breast cancer, and is the main reason MRI is not recommended for them.

The new guidelines, from the American Cancer Society, recommend MRI screening in women who are healthy but at high risk for breast cancer. The guidelines, being published in the society's journal entitled CA: A Cancer Journal for Clinicians, recommend MRI scans and mammograms once a year starting at age 30 for women in the high- risk category.

High risk is defined as a 20 to 25 percent or higher risk of developing breast cancer over the course of a lifetime. (The average lifetime risk for women in the United States is 12 to 13 percent.)

The high-risk group includes women who have tested positive for certain genetic mutations, BRCA1 or BRCA2, or those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested. Women with even rarer mutations, in genes called TP53 or PTEN, are also advised to be screened, as are women who had radiation treatment to the chest between the ages of 10 and 30, for disorders like Hodgkin's disease.

Others at high risk include women from families in which breast cancer is common, even if no genetic mutation has been identified. Women and their doctors can estimate their odds by using one of several online risk calculators that factor in the medical history of both the woman and her family. A simple calculator is available at www.cancer.gov/bcrisktool. But different calculators can give quite different results, and women may need help from their doctors to interpret the results, said Elizabeth Morris, a member of the expert panel that drew up the guidelines and director of breast MRI at the Memorial Sloan-Kettering Cancer Center in New York.

"Just to figure out who should have it will be the hardest thing," Morris said. "A lot of that onus is put on the referring physician. A lot of women are going to think they're high risk, and they're not."

(c) 2007 International Herald Tribune. Provided by ProQuest Information and Learning. All rights Reserved.