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MRI Useful in Breast Cancer Screening

Posted 12/15/2013

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There apparently is no end to the debate about breast cancer screening, what is valuable and what is less so. Most of the discussion focuses on mammography as that continues to be the standard of care for most American women, whether or not they have previously had breast cancer. Breast MRI, a more expensive and more invasive test, is usually reserved for women known to be a high risk. This then easily leads to the questions re the definition of high risk and, as always, what makes sense in terms of public health policy may not make sense or be the right thing for one individual woman.

  At least at my institution, most medical oncologists are willing to order breast MRIs for patients who want them. I suspect that is not always the case as there isn't evidence to support their use in all instances, and they have known drawbacks. The most commonly offered negative is that, because MRIs are so precise, they pick up anything that is there, can't differentiate what it is, and this leads to unnecessary biopsies. Plenty of women dispute this, saying they would prefer to have a biopsy that turns out to be okay than to miss an early cancer. This is a great example of the distinction between what is possibly good for a single woman and not good for a whole population as policy is planned.

  Anyway, today's entry is about a report at SABS (San Antonio Breast Cancer Symposium) that suggested that MRIs actually may have value for broader use. The summary statement is that in a group of previously screened (mammogaphy) normal risk women with no personal history of breast cancer, breast MRIs found a higher number of breast cancers than had the earlier screening tests. Here is the start and a link:

MRI 'Useful' in Breast Cancer Screening

SAN ANTONIO -- Even for women at
average risk of breast cancer, screening by
magnetic resonance imaging can detect
small malignancies that would otherwise
be missed, a researcher said here.
In a prospective study, the vast majority of
MRI scans found nothing out of the
ordinary in a cohort of women whose
mammograms, ultrasounds, and clinical
exams were all normal, according to
Simone Schrading, MD, of the University of
Aachen in Germany.
But in 3.2% of the scans, investigators
found something that required a biopsy,
although half turned out to be benign,
Schrading reported at the San Antonio Breast Cancer Symposium here.
MRI screening is recommended for women with high risk of breast cancer, but not for those
whose risk is average, Schrading noted.
But the findings suggest such screening would be "useful ... . The additional cancer detection
rate is high, even in heavily pre-screened women."

http://www.medpagetoday.com/MeetingCoverage/SABCS/43398

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