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Effectiveness of Breast Cancer Screening Methods in High Risk Women

Posted Mar 19 2010 8:05am
The current breast cancer screening guidelines from the American Cancer Society recommend that women at high risk for breast cancer receive both a yearly mammogram in addition to a yearly magnetic resonance imaging (MRI) scan starting around 25-30 years of age.  Women at elevated risk for breast cancer are generally those with gene mutations that increase breast cancer risk or have an elevated risk (> 20% lifetime risk) due to family history. 

A new study published in the March 20th issue of the Journal of Clinical Oncology examines the effectiveness of different breast cancer screening methods in women at elevated breast cancer risk.  For this study, investigators followed 687 women without breast cancer through nearly 1,700 annual screening rounds.  Screening methods included clinical breast examination, mammography, ultrasound, and MRI.  Of the women enrolled in the study, 27 were diagnosed with breast cancer during the study.  Analysis of the different screening methods to determine their effectiveness of detecting breast cancer showed
  • Ultrasound alone detected breast cancer at a rate of 6 of 1,000.
  • Mammography alone detected breast cancer at a rate of 5.4 per 1,000.
  • Mammography + ultrasound slightly increased the detection rate to 7.7 per 1,000.
  • MRI achieved a breast cancer detection of 14.9 of 1,000.
  • Combining MRI with ultrasound did not improve upon MRI alone.
  • Combining MRI with mammography slightly increased breast cancer detection to 16 of 1,000.
  • MRI scanning showed the highest sensitivity (92%) and highest positive predictive value (48%).
This study confirms the importance of using MRI as a breast cancer screening tool for women at high risk of breast cancer.  Additionally, this study reports that screening with both MRI and mammography is only slightly better than MRI alone.  Because of this observation, the study investigators suggest that breast cancer screening guidelines might need to be revisited for women at high risk for breast cancer if future studies confirm that breast cancer screening by MRI alone might be sufficient. An editorial that accompanies the research article discusses this recommendation in detail and is worth reading.  This editorial suggests that mammograms remain a part of annual screening in women with high risk of breast cancer for several reasons.  Some of these reasons include (1) the fact that other studies have reported that MRI + mammography was substantially better than MRI alone and (2) MRI expertise is variable among medical centers.  For now it appears that MRI + mammography might be the wiser breast cancer screening choice; however, as MRI techniques continue to improve it is possible that women at high risk for breast cancer might be able to reduce their screening routine to only one type of annual screening.

Routine screening is a vital part of our fight against breast cancer and something everyone can make part of their arsenal.  Read my book Fight Now: Eat & Live Proactively Against Breast Cancer ( ) to learn about other lifestyle choices you can make to reduce your breast cancer risk.
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