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    Mammography: 'Gold Standard' Could Use Some Polish


    One hope is that the newer devices will find breast anomalies smaller than a grain of sand, which mammography can't detect. MRIs, or magnetic resonance imaging scans, already have that ability, and they're being studied in women who have a greater risk of developing breast cancer because they carry mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.

    "These are women who have a much, much higher probability of a diagnosis of breast cancer at a much earlier age," Smith says.

    Another plus with MRI, says Barnett Kramer, MD, MPH, a director for the National Institutes of Health, is that women wouldn't have to be subjected to repeated X-rays from a young age. MRIs, Kramer tells WebMD, don't carry the radiation risk that mammograms do.

    On the other hand, doctors don't yet have extensive experience interpreting MRIs of the breast, so it's not clear just what would constitute a normal or abnormal test.

    Another issue discussed in the report and debated among experts is whether the current insurance payment rate for mammography services is adequate. The Medicare and Medicaid reimbursement rates for mammography don't cover the full cost of the expensive test, and private insurers may pay even less, causing some to wonder if radiologists and technicians will want to continue performing the service.

    "Some experts caution that the availability of mammograms could be shrinking. ... As a result women in this country are often forced to wait weeks or even months for their annual breast cancer screening because of scaled back or closed mammography centers. These delays can result in more advanced and less treatable forms of breast cancer," says Sen. Tom Harkin (D-Iowa).

    To thwart reduced access to mammography, Harkin, along with a bipartisan group of legislators, plans to introduce this week a new bill that would increase the mammography reimbursement rate. Currently Medicare picks up most of the tab for the service.

    And what about the controversial question of when to start breast cancer screening? It could be a life or death question. The IOM report didn't weigh in on that, but a few things are clear. The expert consensus is that all women aged 50-69 should get the test annually.

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