Tuesday, April 17, 2007

MRI now recommended for high-risk breast cancer screening

Breast cancer screening just got better for women at a high (20-25%) lifetime risk of developing a malignant breast tumor. The American Cancer Society released new screening guidelines this year recommending MRI scans for women with strong family histories of breast cancer.

In 2004, a study of over 1900 high-risk women in the Netherlands compared MRI technology with standard mammograms. Analysis of 45 cancers found over the course of 3 years showed that mammograms detected 18 tumors--10 of which were visible by MRI--and missed 27 tumors. Of 32 tumors found on MRI, 22 were not visible on mammogram. Four tumors arose during the intervals between screening tests, and one tumor was detected only by clinical breast examination.

Because some tumors (nearly 18% in this series) are only detectable by mammograms, the ACS guidelines recommend both MRI and mammographic screening in high risk women. While MRIs are known to be sensitive tests for identifying cancers in very dense breast tissue (which are very hard to read on mammograms), the ACS stopped short of recommending this technique for routine use in women with dense breasts, even though such a breast pattern is associated with a six-fold increased risk of cancer.

Eventually, insurance coverage will follow these guidelines. Meanwhile, I'm considering springing for the $1,000+ test for myself.

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