Breast Health

New Study Finds MRI more effective in detecting breast cancer for high-risk women 

Technology proves valuable, but experts emphasize need for regular mammograms

A new study by Dutch researchers finds that magnetic resonance imaging (MRI) can find some breast cancers that mammograms miss in high-risk women. The study, published in the New England Journal of Medicine,  strongly suggests that screening with both MRI and mammography may be more effective for high-risk women than using either test on its own.

"These new investigations expand our knowledge in a very important area, which is how to screen for breast cancer in very high-risk groups," said Robert Smith, PhD, director of cancer screening for the American Cancer Society. "The amount of information we have is quite thin with respect to the best way to screen in women who are at higher risk."

"Part of the reason this study is significant is the size of the population studied," says Dr. Jennifer Harvey, professor of Radiology and co-director of the Breast Care Center at UVa's NCI Cancer Center . "There have been prior studies with 30-50 women that suggested MRI was more effective for high-risk women. But this study, which involves over 1,900 women, is by far the largest published to date"

MRI Not Appropriate for Average-Risk Women

The study does not suggest that MRI is an appropriate screening tool for women at average risk of developing cancer.

"Most women overestimate their risk of developing breast cancer," says Dr. Harvey. "Genetic predisposition really only accounts for approximately 5% of breast cancer cases."

There are several reasons why an MRI study is not of particular benefit to women of average risk for developing breast cancer.

  • "MRI is not as good at detecting the very earliest stages of breast cancer, which are seen better on a mammogram" says Harvey.
  • In addition, the study found that breast MRI conducted on women of average risk resulted in many false positive readings--a finding of cancer where there actually was none. In the study, screening by MRI led to twice as many unneeded additional examinations as mammography (420 vs. 207) and three times as many unneeded biopsies (24 vs. 7).
  • Finally, an MRI is expensive, running about $1,000 to $1,500, compared to $100 to $150 for a mammogram. Most insurance companies do not reimburse for screening breast MRI for women who are not considered high risk.

Who is considered "High Risk"?

You may be considered at high risk for developing breast cancer if any of the following are true:

  • You carry a known genetic marker such as the BRCA1 or BRCA2 gene
  • You have a strong family history of breast cancer
  • You have had breast cancer in the past.

MRI is also better at detecting cancer in women with very dense breast tissue.

"At UVa, we have been offering this option to high-risk women for years," says Harvey. "It is also important to realize that breast MRI is difficult to do correctly, and needs a setting that has real expertise in interpreting diagnostic tests for breast cancer. For instance, a standard MRI is not sensitive enough to detect breast cancer: for that, you need specially-designed MRI coils that allow the MRI to see just the breast tissue in greater detail. And you need specialists who can interpret that test correctly."

UVa has Virginia's only dedicated Breast Care Center, combining surgery and leading-edge radiology, and also provides breast MRI services

Women who are at high risk should consider a breast MRI in combination with a regular mammogram.

The Take-Away: Get that mammogram

"Women need to understand that MRI is not a replacement for an annual mammogram" says Harvey. "Even high-risk women need to talk to their physicians about having a breast MRI in addition to regular mammograms."

Annual screening with mammography is already recommended by the American Cancer Society and other organizations for women 40 and older with an average risk of getting breast cancer.

But many women ignore recommendations to undergo regular mammograms, and as a result miss out on the lifesaving benefits of the screening exam, according to a study reported in Cancer, a journal of the American Cancer Society (ACS).Photo of a woman having a mammogram

Only one in 20 women consistently follow the recommendation for annual mammograms for women age 40 and older, said lead author Dr. James Michaelson, assistant professor of pathology at Harvard Medical School and Massachusetts General Hospital.

ACS guidelines advise high-risk women to discuss with their doctor other screening methods -- like MRI or ultrasound -- that can be used to supplement regular mammography. So far, though, there is not enough evidence to recommend MRI or another screening tool instead of mammography for these women.

Breast cancer is the most commonly diagnosed cancer in US women, according to the ACS, with an estimated 275,380 new cases expected in 2004 and about 40,580 deaths expected.

For comprehensive breast health information, click here or visit  www.uvahealth.com .

Always consult your physician for more information.

August 2004

New study reveals value of MRI for women at high risk

MRI Not appropriate for women of average risk

Who is considered "High Risk?"

Get that Mammogram

Online Resources


What Is a Mammogram?

A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.

The procedure allows detection of breast cancers, benign tumors, and cysts before they can be detected by palpation (touch).

Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy.

Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer.

Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results.

Today, dedicated equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose. Radiation risks are considered to be negligible.

The recent development of digital mammography technology shows promise for improved breast imaging. Digital mammography provides electronic images of the breasts that can be enhanced by computer technology, stored on computers, and even transmitted electronically in situations where remote access to the mammogram is required.

The National Cancer Institute describes the following:

screening mammogram
A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.

diagnostic mammogram
A diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.

A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.

Always consult your physician for more information.


Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Cancer Society

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Cancer Institute

National Institutes of Health (NIH)

National Women's Health Information Center

Susan G. Komen Breast Cancer Foundation