More women with family breast cancer history inquiring about MRI screening following ACS guidelines

Apr 2 2007

More women with a family history of breast cancer are asking their physicians whether they should undergo breast magnetic resonance imaging scans after American Cancer Society guidelines released on Wednesday recommended the screening for women at high risk of developing the disease, the Baltimore Sun reports (Roylance, Baltimore Sun, 3/30).

The ACS' new guidelines, which appear in the March/April edition CA: A Cancer Journal for Clinicians, recommend that women at high risk of developing breast cancer undergo an MRI scan and mammogram once each year beginning at age 30.

High risk is defined as at least a 20% to 25% chance of developing breast cancer during their lifetime. The high-risk group includes women who have tested positive for BRCA1 or BRCA2 gene mutation or who have had a mother, sister or daughter who has tested positive for one of the mutations.

Women who have had at least two close relatives who have had breast cancer or who themselves have had chest radiation for Hodgkin's disease are considered high risk.

The group of experts assembled by ACS, who examined research on MRIs since 2002, said that MRI screening in addition to standard mammography can double the number of cancers identified.

MRIs often produce false-positives at about twice the rate of mammography, but the panel said the benefits outweigh the risks for women in the high-risk group.

The panel also said that MRIs, which cost between $800 and $2,000, are cost effective for the high-risk women (Kaiser Daily Women's Health Policy Report, 3/28).

According to the Sun, physicians have a variety of "quick and inexpensive" statistical models to assess a woman's breast cancer risk. Nagi Khouri, director of breast imaging at the Johns Hopkins Avon Foundation Breast Center, said that public awareness of the importance of family medical history has been growing, adding, "The greater the number of family members (with breast cancer), the more worried they are, and they're asking, 'What more can I do?'"

Khouri said that a potential "stumbling bloc[k]" to expanding MRI screening "will be what the insurers will do," adding that the new ACS guidelines might prompt them to cover the procedure.

It also is likely that less-costly screening technologies under study, such as ultrasounds, might receive renewed support as a result of the guidelines, the Sun reports (Baltimore Sun, 3/30).

NPR's "Morning Edition" on Wednesday reported on the recommendations.

The segment includes comments from Connie Lehman, a breast imaging specialist at the University of Washington Medical Center and a member of the American Cancer Society panel, and Robert Smith, director of cancer screening at ACS (Neighmond, "Morning Edition," NPR, 3/28). Audio of the segment is available online.