Breast Cancer Health Center

Christina Applegate's Breast Cancer: FAQ

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Editor's note:The Gail risk model, which is for women who are at least 35 years old, estimates a woman's odds of developing breast cancer based on her current age, her age when she first menstruated, her age when she first gave birth, family history of breast cancer, past biopsies, and race.

We also look to see if they have dense breasts, because it makes it theoretically more difficult to read the mammogram. So in her particular case, even if she didn't test positive, she's clearly young, there's clearly a family history, she's clearly had a breast cancer, she probably has dense breasts given her age, I would certainly consider getting MRIs on her every year or every other year, probably every year. If she didn't have a family history and she's 55 and her breasts are a little bit less dense because she's had a couple of kids ... then I might not get that routine MRI.

So I look at the other factors, look at what the mammogram looks like, have a conversation with the patient, but there is not a routine patient that I get routine MRIs on other than very high risk or BRCA1 or BRCA2 positive.

And the downside is the risk of false-positive results (suspicious findings that turn out not to be cancer)?

Oh yeah, and we can't afford it. I know people don't like to hear that answer, and for individual patient it's really not anything that plays a role in most of our decision making. But from a society perspective, if we started doing MRIs willy-nilly, I think there was an estimate last year ... probably in The Wall Street Journal, that we would spend something like a billion dollars a year between additional screening and biopsies for the things that come up. That's a lot of money, and we need to start making decisions that have some rational decisions from a medical-economic perspective. Again, not that you would apply that for an individual patient, because you never do that. But in making recommendations that are going to have societal implications, I think you have to do that.

Do you have patients asking you why can't I get an MRI? What do you tell someone who's not at high risk?

I try and give them the right answer ... and go through the false-positives. ... I don't know if you've had a mammogram ... it's not the most pleasant thing in the world but it's not horrible. You go in, you put your breasts on the thing, it squishes them, and you leave. I'm not trying to minimize it. But now you talk to the people who've had MRIs and they hate them. No. 1, you have to get an IV because it's given with contrast. No. 2, you're not getting squished but you're lying face down in this machine that drives people crazy, makes a lot of noise, you're in a very confined environment. People don't like it, and theoretically you can get renal insufficiency, kidney damage, from the dye. And so now we've gone from a test, a mammogram, where it's sort of uncomfortable but it's not going to do harm to you, to a test that's very expensive, has lots of false-positives, and can actually do harm. So you don't just do it because you think it's a good idea. That's the first thing I do -- I explain downsides to them. And if they still want it, I'll write them a prescription, but more than likely the insurance company is going to kick them out because it's so much more expensive.