MRI scan increases breast cancer detection rate

Magnetic resonance imaging is more effective at detecting breast cancer in high risk women than traditional mammography, a new study has revealed.

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By  Stuart Qualtrough Published  May 16, 2005

Magnetic resonance imaging is more effective at detecting breast cancer in high risk women than traditional mammography, a new study has revealed. Researchers in the UK say use of MRI scans could reduce the need for precautionary breast removal operations. They found the scans were almost twice as sensitive as X-ray mammography (XRM) in detecting cancer in women under 50 at high genetic risk. Women with one of these gene mutations come from families where there is a strong family risk of breast cancer, and more than half of them will develop breast cancer by the age of 70. Annual mammograms are offered to women with these gene mutations to allow early identification and treatment of tumours. However, as women below the age of 50 often have dense breasts, mammography is not always very effective at detecting tumours. As a result, around 40% of women at high risk opt to have their breasts removed rather than run the risk of developing cancer. More accurate diagnosis of cancer would mean that treatment could start at an early stage, and surgery would require the removal of just the affected tissue, rather than the whole breast. The latest study, which included 649 women, looked at whether MRI would be more helpful in detecting tumours within this group. It found that MRI managed to identify 77% of tumours in women at high genetic risk - compared to just 40% using XRM. Combining both XRM and MRI screening methods, enabled the detection of 94% of tumours. MRI screening was particularly effective for women known to carry the BRCA1 gene mutation - detecting 92% of tumours, whereas XRM only detected 23%. About 1% of women are at very high risk of developing breast cancer resulting from a proven or suspected inherited predisposition. Onset of cancer is often at a young age. One very effective option for these women is bilateral prophylactic mastectomy. However, this mutilating procedure is unacceptable to most women with proven gene mutations. It is even less acceptable to women with a strong family history of the disease but indeterminate mutation status, who have no means of ascertaining whether their lifetime breast cancer risk is as low as that of the general population (around 10%), or as high as that of a mutation carrier (around 85%). For lifelong surveillance to be a reasonable alternative to mastectomy, almost all cancers must be found at the pre-invasive or early invasive stage, when the cure rate is over 90%. As no randomised trial for breast screening has been done in the high-risk population, the mainstay of surveillance guidelines, extrapolated from general population studies, has been annual mammography starting no later than at 30 years of age.

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