Is MRI Better Than Mammography?
European Studies Indicate High-Risk Women Can Benefit From MRI Screening for Breast Cancer
Robson points out, however, that women who have the breast cancer gene usually have only one mutated copy. This leaves them with one "good" gene, "which is enough to repair the damage caused by low-dose radiation."
Jan G. M. Klijn, MD, PhD, of the Erasmus Medical Center at the University Medical Center in Rotterdam, Netherlands, agrees with Kuhl's assessment of the benefits of MRI.
The Dutch MRI Screening Study followed 1,905 women with BRCA1, BRCA2, or a strong family history of the disease for two years, doing MRI every six months. "We identified 40 cancers, and most of them were less than one centimeter in diameter," he says. Moreover, 77% of the women in his study had node-negative disease, indicating that the cancer had not spread beyond the breast.
He says that self-exam detected 16% of tumors, while mammography detected 36% compared with a 71% detection rate for MRI. Nonetheless, Klijn agrees that MRI was more likely to find false positives than either breast clinical exam or mammography.
The investigators also say MRI did find lesions early, at a more curable stage, and suggest that women at high risk of the disease may benefit from MRI.
Rebecca Garcia, PhD, vice president of health sciences at the Susan G. Komen Breast Cancer Foundation, tells WebMD although MRI represents an exciting, emerging technology, "I agree with Dr. Robson that it is not yet ready for prime time."
Garcia says that before MRI can be recommended for even high-risk women, the U.S. needs more doctors trained to interpret MRI images and more standardization of MRI equipment to reduce the false-positive rate.
Robson says cost is another barrier for American women. He says that in the United States, MRI screening costs about $1,500 plus about $500 more for medical review of the scan, compared with just $300 or so for mammography. Klijn says this is not the case in the Netherlands. "MRI costs about $200 in Holland and mammography costs about $70."
Garcia says that she hopes "we can reduce costs here as well, but we need the science first."