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Jefferson Chair of Radiology Says MRI Has Value for Screening Certain Women for Breast Cancer

Vijay Rao, MD, agrees with recent guidelines announced by American Cancer Society and findings of study funded by National Cancer Institute

During the last week in March, the American Cancer Society (ACS) announced new guidelines advising women with an unusually high risk of developing breast cancer to get an annual magnetic resonance imaging (MRI) scan along with their yearly mammogram. The ACS says that the two tests together give doctors a better chance of finding breast cancer early, when it is easier to treat and the chance of survival is greater.

The new ACS guidelines also advise most women at high risk for breast cancer to begin getting MRIs and mammograms at age 30. (For women at average risk, ACS recommends getting annual mammograms and breast exams beginning at age 40.)

Simultaneously with the ACS’ announcement, the New England Journal of Medicine released the results of a national study sponsored by the National Cancer Institute (NCI). The study concluded that women who have been diagnosed with cancer in one breast should have an MRI scan of the other breast as soon as possible.

MRI, or magnetic resonance imaging, makes more detailed images with a magnet and radio waves, but without radiation. MRIs are better at showing increased or abnormal blood flow in the breast, a sign of early cancers not visible on a mammogram. They are also better than mammograms at detecting cancer in women with dense, non-fatty breasts.

Vijay Rao , MD, Professor and Chair of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College of Thomas Jefferson University, agrees with the new ACS guidelines, as well as with the findings of the NCI-funded study, of which Jefferson Hospital was one of 25 participating institutions nationally.

“Until recently, MRI technology hasn’t really been used too effectively screening breast cancer,” Dr. Rao says. “Now, it’s beginning to receive recognition for its value in this regard. I’m totally in favor of women who are at high risk for breast cancer or who have already been diagnosed with cancer in one breast to get an MRI study done.”

Vijay M. Rao, MD

Highly sensitive screening tool
Dr. Rao acknowledges, however, that although a powerful screening tool, MRI’s highly sensitive nature can cause it to detect “false positives,” which are lesions that turn out to be benign or non-cancerous. This, along with the fact that an MRI scan is expensive, makes it an impractical breast cancer screening tool right now for patients at average risk.

“On the one side of the MRI coin, it allows us to detect cancers very early on,” Dr. Rao says. “But on the other, it does find many lesions that don’t turn out to be cancerous but which is only determined after patients undergo a biopsy of those lesions, causing them short-term anxiety.

“Within the high-risk population, and for women already diagnosed with breast cancer in the other breast, the short-term anxiety of biopsy is worth the benefit of MRI screening,” she stresses. “If the result of the biopsy is negative, the patient has peace of mind. And, of course, if biopsy confirms a cancerous lesion detected by MRI, it’s a lifesaving procedure.”

The new ACS guidelines recommend MRI screening in addition to mammogram for women who meet at least one of the following conditions:

• They have a BRCA1 or BRCA2 mutation. (BRCA1 and BRCA2 are tumor suppressor genes. When they are mutated, they no longer function to suppress abnormal growth, and cancer is more likely to develop.)
• They have a first-degree relative (parent, sibling or child) with a BRCA1 or BRCA2 mutation, even if they themselves have yet to be tested.
• Their lifetime risk of breast cancer has been scored at 20-25 percent or greater, based on one of several accepted risk assessment tools that look at family history and other factors.
• They had radiation to the chest between the ages of 10 and 30.
• They have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley- Ruvalcaba syndrome, which are rare, inherited family traits carrying an increased risk of cancer during childhood and early adulthood, or may have one of these disorders based on a history in a first-degree relative.

Expensive/coverage limited
Because an MRI scan are expensive, its use as a screening tool has to be carefully examined. However, in high-risk breast cancer patients, it now has been shown to be particularly effective.

“I don’t know how soon insurers may change their policies regarding paying for MRI scans in women who meet any of these criteria,” says Dr. Rao. “But because of all of the media coverage these breakthroughs are generating, and the emotional response to stories about breast cancer, insurers will certainly be under a lot of pressure. MRI is now beginning to receive recognition of its value as a screening technology for breast cancer. Hopefully, further research will provide more conclusive evidence of that. ”

Dr. Rao also acknowledges that one or more emerging technologies, including metabolic imaging (PET and gamma imaging), digital tomosynthesis, optical imaging, advanced ultrasound and elastography, could turn out within the next several years to be as or more effective and less expensive than MRI as a breast cancer screening tool.

Turn to experts
Dr. Rao stresses that patients should be discerning about where they go to have an MRI scan for breast cancer. “An inadequately performed MRI can give false assurances to a patient,” she cautions. “Open MRI technology is inadequate for breast imaging; only high-resolution imaging with dedicated breast coils is appropriate. The American College of Radiology is talking about accrediting facilities that do breast MRI, which I am strongly supportive of. We use only high-resolution MRI technology at Jefferson Hospital, and are working toward having dedicated breast MRI technology at Jefferson-Honickman Breast Imaging within the year.”