Wall Street Journal Examines Use Of MRIs, Ultrasound In Detecting Breast Cancer

Main Category: Breast Cancer
Also Included In: MRI / PET / Ultrasound
Article Date: 26 Jun 2008 - 9:00 PDT

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Although annual mammograms for many years have been the "simple prescription" for women concerned about breast cancer, physicians are now increasingly recommending that women at higher risk for the disease receive other tests, such as an MRI or ultrasound, which are potentially more sensitive forms of screening, the Wall Street Journal reports. According to the Journal, the "heightened interest" in additional screening is the result of new guidelines that were issued by the American Cancer Society last year. The guidelines recommended annual MRIs, in addition to mammograms, for women with certain genetic mutations tied to breast cancer and whose family history of the cancer is elevated, among other high-risk categories.

Although health insurers generally cover ultrasound screenings, which can cost $100 or less, they only guarantee MRI coverage, which can cost $1,000 or more, for women at high risk, the Journal reports. MRI screenings, however, are more successful at detecting breast cancer than ultrasounds. In addition, although Medicare covers mammograms, it does not pay for an ultrasound or MRI as part of a routine screening; it will only pay if a physician deems the screenings medically necessary, a Medicare spokesperson said.

After the release of the ACS guidelines, a series of studies -- including one in the New England Journal of Medicine -- found that an MRI can detect cancers missed by mammograms. On the other hand, MRI and ultrasound screenings can produce many false positives, creating unnecessary anxiety for many patients, according to the Journal. Another study in the May issue of the Journal of the American Medical Association also found a link between ultrasounds and false positives.

Jerry Gehl -- medical director of St. Vincent Breast Center in Little Rock, Ark. -- said that he began routinely recommending MRIs to high-risk patients, as well as mammograms, after ACS' guidelines were released. In general, however, he does not recommend an MRI to patients who only have a somewhat-elevated risk of breast cancer. "You have to draw that line somewhere," Gehl said.

According to the Journal, medical practitioners are divided about the use of ultrasounds in breast cancer screening. Wendie Berg -- a radiologist at a clinic in Lutherville, Md., who was the lead author of the JAMA study -- said she recommends ultrasound screenings to some women who do not have evidence of very high risk that would necessitate an MRI. "It is a judgment call," Berg said, adding, "The denser the breast, the more difficult the mammogram is to read, the more likely I am to recommend an ultrasound." However, Constance Lehman, a University of Washington researcher who led the NEJM study, said she never advises ultrasounds for patients. "We find it ineffective as a screening tool. It's not even in the same ballpark" as an MRI, Lehman said (Wilde Mathews, Wall Street Journal, 6/24).

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