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Susan G. Komen for the Cure Offers Perspective on Use of MRI Screening in Women at High Risk for Breast Cancer

Posted on: Friday, 30 March 2007, 09:00 CDT

DALLAS, March 28 /PRNewswire/ -- The value of magnetic resonance imaging (MRI) for earlier detection of breast cancer is supported by new recommendations and clinical trial information published March 28. The American Cancer Society (ACS) released new guidelines for breast screening, recommending that women at a very high lifetime risk for breast cancer receive yearly screening MRI in addition to mammography. This is the first ACS guideline update by ACS on early detection of breast cancer since 2003. The new guidelines were published in the ACS journal CA March 28, 2007.

In addition, the National Cancer Institute (NCI) and the American College of Radiology Imaging Network (ACRIN) March 28 reported on results from a breast cancer clinical addressing the ability of MRI to detect early stage breast cancer.

ACS Recommendations on MRI Use

For women with a lifetime risk of 20-25 percent or greater of developing breast cancer, the ACS recommends annual MRI screening. According to the article, this includes those women with the following risk factors:

-- having the BRCA mutation -- being a first-degree relative of a BRCA carrier or having a strong family history of ovarian cancer -- having been treated for Hodgkin's disease between the ages of 10-30 years (Treatment includes radiation to the chest area.)

Other risk groups where the data was not sufficient to recommend the use of MRI for screening included those with:

-- a lifetime risk of 15-20% -- lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) -- atypical ductal hyperplasia (ADH) -- very dense breasts -- a personal history of breast cancer, including ductal carcinoma in situ (DCIS) (1)

MRI was not recommended for those women with a less than a 15 percent lifetime risk for developing breast cancer.

For patients with a very high risk for developing breast cancer, early detection is extremely important and often very difficult with mammography alone. Recent studies have shown that MRI is more sensitive than mammograms in finding tumors in those women with a genetic risk for breast cancer. (2)

No survival or mortality data was available to use in making these recommendations.

For those high-risk women who don't fit into the ACS recommendation profile for receiving MRI screening, the ACS recommends that they be offered MRI screening clinical trials.

ACS issued the following recommendations: "Women should be informed about the benefits, limitations, and potential harms of MRI screening, including the likelihood of false positive findings. Recommendations are conditional on an acceptable level of quality of MRI screening, which should be performed by experienced providers in facilities that provide MRI-guided biopsy for the follow-up of any suspicious results."

Susan G. Komen for the Cure Perspective

Early detection is important to every person at risk for developing breast cancer. When breast cancer is detected early, there are more treatment options available which can lead to a better chance for survival.

A number of inherited mutations have been linked to breast cancer, including mutations in the following genes: BRCA1, BRCA2, p53, ATM, CHK2 and PTEN/ MMAC1. Although these mutations greatly increase the risk of developing breast cancer, they are very rare in the general population and account for 5 to 10 percent of all breast cancers diagnosed in the U.S.

Of the genes linked with breast cancer susceptibility, mutations in BRCA1 and BRCA2 (standing for BReast CAncer gene 1 and 2) are the most well-recognized. It is estimated that about 250,000 women in the United States carry a BRCA1 or BRCA2 mutation, and these women have a significantly elevated risk of breast cancer. (3)

Options for those at higher risk can include more frequent screening tests, having preventive surgery and taking risk-lowering drugs, like tamoxifen. (3)

While MRI is known to be more sensitive than mammography and can find smaller tumors, its specificity causes concern for some. More false positive results are likely. Additional tests, including biopsy, may be necessary to determine the significance of MRI-derived results to rule out cancer. This adds expense and stress for the patient.

The cost is significantly more for MRI screening than for a mammogram. Many insurers have been reluctant to cover the cost of even a diagnostic breast MRI, which could portend a lack of coverage for screening MRI. Access to MRI screening will be a critical issue for many patients, particularly those who live in rural areas where screening mammography is not always accessible.

Patients should be aware that specially designed equipment is needed to provide breast MRI screening and radiologists require extensive experience in breast MRI to provide the service.

Dr. Cheryl Perkins, M.D., senior clinical advisor for Susan G. Komen for the Cure said, "The importance of developing more and better tools for early detection cannot be underestimated. No single technology is perfect. It is the combined use of screening options available today that will result in the best chances for early detection. Screening with risk- appropriate technology and at risk-appropriate ages and frequency in combination with regular clinical and breast self-exams will increase the likelihood of being able to find and treat breast cancer early."

NCI/ACRIN Findings on MRI

Providing MRI screening of both breasts to women who have been diagnosed with breast cancer in one breast may decrease the need for future surgeries, researchers at the National Cancer Institute reported March 28.

"One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast," commented NIH director Elias Zerhouni, M.D., about the American College of Radiology Imaging Network (ACRIN) clinical trial evaluating the use of MRI when breast cancer is first diagnosed.

According to the report, more than 90 percent of cancers in the opposite breast found by MRI had been missed by mammography and clinical breast exam in patients when their breast cancer was first diagnosed. Cancer type, age and breast density did not affect the benefits of using MRI to help detect breast cancer.

A negative MRI suggests that the likelihood of having cancer in the opposite breast is very low. Because of these findings, it was suggested that:

-- providers will now be able to determine before the first surgery if there is cancer in the opposite breast; -- surgery on the opposite breast can be done when cancer is first diagnosed instead of months or years later if cancer is present there; -- a negative MRI will reduce the number of bilateral mastectomies by increasing the confidence that there is a low likelihood that there is cancer in the opposite breast.

According to Constantine Gatsonis, Ph.D., Director, Brown University Center for Statistical Sciences who served as statistician for the study, "Women can be assured that a negative MRI means that their chance of having a second cancer diagnosed within a year is miniscule."

Susan G. Komen for the Cure Perspective

The use of tools such as MRI to help plan treatment and to reduce the risk for more surgery later on is a big step. Use of screening MRI will likely increase the chances that patients can face a future after breast cancer treatment with less risk for recurrence or the possibility of a second cancer in the opposite breast.

"Earlier detection techniques must be developed and used in order to increase survival and decrease breast cancer mortality. Continued follow-up will add data to support the use of MRI and the issues associated with it. Continued clinical trials will bring us more options for early detection in the future," said Cheryl Perkins, M.D., senior clinical advisor for Susan G. Komen for the Cure.

For more information, or to schedule an interview with a Susan G. Komen for the Cure representative, please contact: Jean Maza, 972-701-2105 or Amber Cradduck, 972-830-2721.

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20070122/NYM084LOGOPRN Photo Desk photodesk@prnewswire.com

Susan G. Komen for the Cure

CONTACT: Jean Maza, +1-972-701-2105, or Amber Cradduck, +1-972-830-2721,both for Susan G. Komen for the Cure

Web site: http://www.komen.org/

Source: PRNewswire

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