CHICAGO - Citing continuing problems with specificity, the lead investigator in a U.S. study of MRI for screening of women who are genetically predisposed to breast cancer said it is too soon to recommend that MRI screening replace mammography for high-risk women.
"We cannot recommend MRI screening at this time," said Dr. Mark Robson Monday during a press conference at the American Society of Clinical Oncology. Robson is an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City.
Robson reported on a series of 54 women with either BRCA1 or BRCA2 mutations who were followed from July 1998 until April 2003. During that time the women underwent 97 MRI exams for breast cancer screening.
Two women were diagnosed with ductal carcinoma in situ after an abnormal MRI, and one of these was mammographically occult, Robson said. But more than 36% of the MRI screenings were initially judged abnormal, and follow-up MRI was recommended. After follow-up, 21 biopsies were recommended, but only three biopsies resulted in a cancer diagnosis, he said. Sensitivity was 100%, but specificity was only 81%.
Moreover, Robson noted that in the U.S., MRI screening costs about $1,500, plus about $500 more for a medical review of the scan, compared to just $300 or so for mammography. "So cost is also a barrier," he said.
Commenting on the study was Rebecca Garcia, Ph.D., vice president, health sciences at the Dallas-based Susan G. Komen Breast Cancer Foundation. Garcia said that her foundation supports MRI studies, and remains committed to improving screening technology, but that "I agree with Dr. Robson that it is not yet ready for prime time."
Before MRI can be recommended for even high-risk women, the U.S. needs more radiologists who are specifically trained in the use of MRI for breast cancer screening, Garcia said. "We also need standardization of MRI similar to the standardization that we have in mammography."
By Peggy PeckAuntMinnie.com contributing writer
June 3, 2003
Related Reading
High breast cancer risk may warrant MR screening rather than mammography, May 7, 2003
Breast cancer in younger women calls for flexibility in imaging, May 2, 2003
Tips and techniques make MRI feasible for breast centers, March 20, 2003
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