By: Red Hot Mamas
Published: May 26, 2010
New guidelines from the American Cancer Society (ACS) may help detect breast cancer earlier than current methods. Early detection increases a woman’s chances of survival by allowing physicians to treat the cancer early. If you are a woman with a high risk of developing breast cancer, one more test should be added to your yearly exam.
These new mandates could add a million or more women a year to those who need breast MRIs. Are radiologists equipped for this increased demand? How practical are the new guidelines? Who is going to pay for the MRI? These questions are all legitimate concerns for women who fall into the category of “high risk”.
The price of a breast MRI is almost 10 times that of a mammogram. Costs can range from $1000 to $2000. A million more scans a year would amount to at least $1 billion. Would insurance cover these costs? Medicare? How important is the MRI actually going to be?
If you are a woman, you are at risk for breast cancer. That’s all it takes! And, the older you are, the higher the chance is of you getting breast cancer. It’s the second-leading cause of cancer death in U.S. women responsible for about 40,000 deaths each year. Have you heard the numbers before? One woman in eight who lives to age 85 will develop breast cancer during her lifetime. For the average woman, ACS still recommends getting an annual mammogram and breast exam by a physician beginning at age 40.
All these facts are not meant to scare you. Over 2 million breast cancer survivors are alive in America today. Of those women diagnosed with breast cancer 5 years ago, 88% of them are still alive. Of those diagnosed 10 years ago, 80% are still alive; of those diagnosed 20 years ago, 63% are still alive. Since we do not know the causes of breast cancer, we cannot prevent it. But we can lower our changes by considering our risk factors and knowing what the numbers mean. Reducing the number of risks should be part of an early detection plan.
The ACS now recommends a screening MRI (magnetic resonance imaging) in addition to a yearly mammogram for women at high risk. Women with a “high risk” are defined as those with a 20 percent to 25 percent or higher chance of developing breast cancer over the course of a lifetime. The “high-riskers” need to begin getting MRIs and mammograms at age 30.
Are You at High Risk?
Many women think they are at “high risk” but actually aren’t. Dr. Elizabeth Morris, director of Breast MRI at Memorial Sloan-Kettering Cancer Center in Manhattan and a member of the expert panel that drew up the new guidelines says, “Just to figure out who should have it (MRI) will be the hardest thing. A lot of that onus is put on the referring physician. A lot of women are going to think they’re high risk, and they’re not.”
If you meet at least one of the following conditions, the ACS recommends an annual MRI screening in addition to a mammogram:
- Having a BRCA1 or BRCA2 mutation (about 5%-10% of breast cancer cases are hereditary as a result of these genetic mutations
- Having a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
- If your lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
- If you’ve had radiation to the chest between the ages of 10 and 30
- If you’ve had Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative
Red Hot Mamas advisor and Clinical Professor of Obstetrics and Gynecology at Yale University School of Medicine, Dr. Mary Jane Minkin says, “Anyone who needs MRIs possibly regularly should probably be under the care of a breast surgeon, who can decide when they are needed. I really don’t think gynecologists are going to be able to order MRIs on demand (or necessarily should be able to) because this is going to bankrupt the healthcare system, unless the price really comes down.”
A confirmed diagnosis of breast cancer is not necessarily a medical emergency. Surgical treatment should be given within a few weeks of diagnosis. It is important that you feel comfortable with the doctor who is in charge of your care. Ask your family doctor or gynecologist for a referral to a breast specialist. The American Board of Medical Specialists can verify a physician’s board certification.
To talk with other women about breast cancer screenings, visit our bulletin boards.
Visit our breast health section for more information.
“American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography” Published in the March/April 2007 CA: A Cancer Journal for Clinicians (Vol.57, No. 2: 75-89). First author: Debbie Saslow, PhD, American Cancer Society.
“Call to Increase M.R.I. Use for Breast Exam” Published in the March 28, 2007 New York Times website
“MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer.” Published in the March 29, 2007 New England Journal of Medicine (Vol. 356, No. 13: 1295-1303). First author: Constance D. Lehman, MD, PhD, University of Washington Medical Center, Seattle.
“Women’s Health Risks.” February 9, 2007 The Mayo Clinic. Retrieved April 6, 2007 from website.