Two new reports concerning breast cancer detection made front page news today. From the Chicago Tribune:
Women who are at high risk for breast cancer should be screened with MRI in addition to mammograms, according to new guidelines from the American Cancer Society.
In addition, top researchers recommended Tuesday that anyone recently diagnosed with cancer in one breast should have magnetic resonance imaging to make sure she’s not harboring an invisible tumor in the other. Their study, published in the New England Journal of Medicine, found that more than 3 percent of new breast cancer patients had cancer in the other breast that standard mammograms and physical examination missed.
Together the developments represent the latest step in the evolution of medical thinking about the use of MRI — a sophisticated and expensive tool — to find breast tumors. But experts caution that healthy women at low or average risk should continue to rely on mammography and physical exams to detect signs of cancer.
Widespread use of MRI, they note, could detect non-threatening cancers that don’t need to be treated and therefore might do more harm than good.
“Finding more cancers is not necessarily a good thing,” said Dr. Steven Woloshin of Dartmouth Medical School. “The key is whether these ‘missed cancers’ are ones that were destined to cause problems, and whether earlier detection and treatment has a net benefit. These issues can only be resolved with a randomized trial.”
The American Cancer Society guidelines were published in the society’s journal CA: A Cancer Journal for Clinicians. Both the abstract and full text are fully available.
Only the abstract of the New England Journal of Medicine study is available for free to non-subscribers.
According to The New York Times, the news could add a million or more women per year needing a MRI, and radiologists are not yet equipped to meet that demand.
Increased demand for such scans could easily outstrip the capacity, even though the number of centers offering them 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. She said professional societies in radiology were scrambling to provide training and accreditation for the scans.
Insurers will probably cover the scans because the new guidelines are based on good evidence and promoted by a respected medical group, said Peter V. Lee, president of the Pacific Business Group on Health, a nonprofit coalition of large buyers of health care that cover about five million people. Huge amounts of money are now wasted on unnecessary M.R.I., Mr. Lee said, adding: “Here we have a case where there’s evidence. Hallelujah! Let’s use it.”
The guidelines mentioned above refer to the American Cancer Society report. But the response is the same with regard to the New England Journal of Medicine study. One of the study’s authors, Dr. Etta D. Pisano, a professor of radiology at the University of North Carolina, said the findings would make it more difficult for insurance companies to refuse to pay for scans of the second breast, if breast cancer is detected.
A breast MRI generally costs between $1,000 to $2,000, or about 10 times the cost of mammography, according to the Times. The story also points out that not all MRI centers are qualified to perform the scans, and those that are not qualified may offer it anyway.
Plus: Freelance writer Marla Brinn describes the uphill battle she fought to get a second opinion after a radiologist found a lump in her breast and advised waiting four to six months for a follow-up mammogram. The story reveals a lot about class, wealth and access to health care — not to mention the insensitivity of some doctors (check out the gynecologist’s comments). Hat tip: Women’s Health News (at a shiny new blog!).