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Breast MRIs advised for high-risk womenFrom: GIN11153@aol.comWed Mar 28 11:48:45 2007
Cancer detection guidelines could mean expensive scans for a million more people 11:49 PM CDT on Tuesday, March 27, 2007
>From Wire Reports Two reports being published today call for greatly expanded use of MRI scans in women who have breast cancer or are at high risk for it. The recommendations do not apply to most healthy women, who have only an average risk of developing the disease. Even so, the new advice could add a million or more women a year to those who need breast magnetic resonance imaging – a demand that radiologists are not yet equipped to meet, researchers say. The scans require special equipment, software and trained radiologists to read the results, and may not be available outside big cities. Breast cancer strikes more than 212,000 American women each year and kills more than 40,000, making it the most common cancer and second-leading cause of cancer death in women, after lung cancer. Routine mammography has helped cut the death rate from breast cancer. But mammograms, which are X-rays of the breast, can miss small tumors. MRI uses magnetic fields instead of radiation to create images after patients are injected with a dye. Breast MRI costs start at $1,000 – many more times the cost of mammography. A million more scans a year would cost at least $1 billion. An MRI is sometimes covered by insurance and Medicare, sometimes not, depending on the reason for the test. One report is a set of new guidelines for using MRI in women at high risk for breast cancer, and 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 – much more so than mammography – 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 considered reasonable for women with just an average risk of breast cancer and is the main reason why MRI is not recommended for them. Group's guidelines The new guidelines are from the American Cancer Society and recommend breast MRI screening in women who are healthy but at high risk for breast cancer. The guidelines, being published in the society's journal CA: A Cancer Journal for Clinicians, recommend MRI scans and mammograms once a year starting at age 30 for high-risk women. 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 U.S. is 12 to 13 percent. The high-risk group includes women who are prone to breast cancer because they 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. These mutations are not common – they cause less than 10 percent of all breast cancers – but they greatly increase a woman's risk, to 36 to 85 percent. 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 ages 10 and 30, for disorders like Hodgkin's disease. Others at high risk include women from families in which breast cancer is common, especially in their close relatives, even if no genetic mutation has been identified. The cancer society said that for women with certain conditions, there was not enough information to recommend for or against MRI screening and that those women and their doctors would have to decide. The uncertain group includes women with very dense breast tissue and women who had breast cancer in the past, or growths called carcinoma in situ or atypical hyperplasia. 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 unneeded biopsies. Ms. Hirsch's mother was found to have breast cancer in 2004, and Ms. Hirsch and her younger sister both tested positive for the BRCA1 mutation. They are among an estimated 22,000 women in the U.S. who have tested positive in the 10 years since the test became available. Downsides Ms. 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 University of North Carolina 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. Dr. Robert Smith, the cancer society's director for screening, estimated that the new guidelines would add between 1 million and 2 million women a year to the number who should have breast MRI. He said previous recommendations, made in 2003, had been less specific about "who's at risk and who's a candidate for being screened." Increased demand for breast MRI could easily outstrip the capacity, even though the number of centers offering the scans has increased markedly in the last five years, said Dr. Constance Lehman, another member of the panel that wrote the guidelines and a professor of radiology at the University of Washington and the Seattle Cancer Care Alliance. She said that professional societies in radiology were scrambling to provide training and accreditation for breast MRI.
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