By Emma Simpson, MD, System Chair of Radiology
Mammography benefits and limitations and the “Dense Breasts” conundrum: Annual screening mammography from age 40-75 has been shown to decrease mortality rates by 25-48%. The effectiveness of screening mammography is limited by breast density. Increased breast density both increases a woman’s risk of breast cancer and lowers the sensitivity for detection. This awareness coupled with patient advocacy lead to the PA breast density notification act in 2013. This information is now mandated to be included in mammography reports and the results letters sent to patients. Seeing these notifications, many patients and providers seek additional screening options. It has been shown to detect an additional 3.5-4.4 breast cancers per thousand screened but at the cost of a low positive predictive value of 8-9%.
Breast MRI standard study benefits and limitations: Breast MRI has been shown to be the most sensitive modality for breast cancer detection with an accuracy similar to mammography. Due to its high cost, it has been advocated as a screening tool for patients with specific genetic syndromes, elevated lifetime risk of breast cancer above 20% or previous radiation treatment to the chest. Dr. Berg’s study in JAMA(5) showed that mammography alone detected 8.2 cancers/1000 and MRI added 17.9 cancers for a yield of 26.1/1000. Adding screening ultrasound detected no additional cancers.
Abbreviated Breast MRI: Many patients’ insurance will not cover a standard breast screening MRI due to its significant expense. This expense is related to the scanning time required to complete it. Abbreviated breast MRI protocols have demonstrated utility and accuracy in preliminary trials and offer a more affordable screening option (6). We are happy to announce that we are now able to perform this study at all four breast centers located at the MLH hospitals. This will be done as a self pay study. It will be offered for $299 and will be an approximately 10 minute scan. Providers and patients should note that the abbreviated breast MRI is intended for screening only and will not provide all of the diagnostic information included in a complete breast MRI. In EPIC this can be ordered as the “Abbreviated breast MRI”.
For questions you can speak with a breast imager or nurse navigator whose phone numbers are listed below:
- Coldman A, Phillips N, Wilson C, et al. Pan-Canadian study of mammography screening and mortality from breast cancer. J Natl Cancer Inst 2014; 106
2. Broeders M, Moss S, Nyström L, et al; Euro-Screen Working Group. The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen 2012; 19(suppl 1):14–25
- Nickson C, Mason KE, English DR, Kavanagh AM. Mammographic screening and breast cancer mortality: a case-control study and meta-analysis. Cancer Epidemiol Biomarkers Prev 2012; 21:1479–1488
- Tabár L, Yen AM, Wu WY, et al. Insights from the breast cancer screening trials: how screening affects the natural history of breast cancer and implications for evaluating service screening programs. Breast J 2015; 21:13–20
- Wendie A. Berg, et al. Detection of Breast Cancer with Addition of Annual Screening Ultrasound or a Single Screening MRI to Mammography in Women with Elevated Breast Cancer Risk. JAMA. 2012 Apr 4; 307(13): 1394–1404
- Marshall H el al., Implementing Abbreviated MRI Screening Into a Breast Imaging Practice. AJR:213, July 2019.