High breast cancer risk? Have MRI with mammogram

New ACS guidelines recommend twofer screening.

Published March 28, 2007 5:10PM (EDT)

The American Cancer Society today issued an official recommendation that women at high risk of developing breast cancer should have annual breast MRIs in addition to mammograms -- beginning at age 30. "The two tests together give doctors a better chance of finding breast cancer early in these women, when it is easier to treat and the chance of survival is greatest," according to the ACS.

The ACS previously recommended that high-risk women discuss with their doctors whether to have MRIs, which (good news) are more sensitive than mammograms, but are therefore (bad news) more likely to produce false positives. False positives, in turn, can lead to unhealthy anxiety and unnecessary biopsies. But a more recent study appearing in the March 29 issue of the New England Journal of Medicine suggests that the risk-benefit analysis swings in favor of MRIs.

Who is at "high risk"? Women who are estimated to have at least a 20 percent chance of developing breast cancer. Mainly, these are women who have tested positive for the BRCA1 or BRCA2 mutations, or whose mothers, sisters or daughters have; also at risk are women with two or more close relatives who've had breast cancer. (A few more risk factors are listed here.)

That's as many as 1.4 million women. Radiologists are actually not sure they can handle the increased demand -- especially, as some doctors note, if some women think they're higher risk than they actually are. "Different [risk] calculators can give quite different results, and women may need help from their doctors to interpret the results," the New York Times reports. "Just to figure out who should have it will be the hardest thing," said Elizabeth Morris, a member of the panel that drew up the guidelines and director of Breast MRI at Memorial Sloan-Kettering Cancer Center in New York. "A lot of that onus is put on the referring physician. A lot of women are going to think they're high risk, and they're not."

Also, MRIs are expensive and at the moment only sketchily covered by insurance. (And they may have the distinction of actually being even more uncomfortable than mammograms.)

Today's Washington Post reports that while many experts welcome the more aggressive guidelines, some have "questioned whether there is enough evidence to justify" them. "You can find a lot of cancer, but that's not the same thing as helping people live longer or better," said Russell Harris, a cancer expert at the University of North Carolina. "It's unclear how many women really will be helped and how many will be hurt by over-diagnosis and overtreatment."

Robert A. Smith, the ACS director of screening, disagrees. "In a population of women who are at significantly high risk, there is a high priority on finding breast cancer. They are willing to put up with more."

Related: Marla Brin's

Update: Here's a link to the National Cancer Institute's Breast Cancer Risk Assessment Tool. But, take note of their disclaimer: "[The tool] was designed for use by health professionals. If you are not a health professional, you are encouraged to discuss the results and your personal risk of breast cancer with your doctor."

By Lynn Harris

Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of BreakupGirl.net. She also writes for the New York Times, Glamour, and many others.

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