There is important new research out tonight which addresses the question: how should women at high risk for breast cancer be screened? Should they get mammograms, or ultrasound, or the newest technology, the breast MRI?

How should women at high risk for breast cancer be screened? Should they get mammograms, or ultrasound, or the newest technology, the breast MRI?

This study looked at women who carry either the BRCA 1 or 2 genes. They make up between five and ten percent of all breast cancer cases, and have a 50% chance of getting the disease by age 50, and an 85 percent chance of having breast cancer by age 70.

So for patients like Estelle Haber, finding the right screening approach is crucial.
“My mother passed away many, many years ago from ovarian cancer so I was always very vigilante about my check ups in ovarian cancer and my breast exams,” recalls Estelle who considers herself lucky. She, just like several of her relatives, was positive for the BRAC-2 mutation, one that puts her at risk for breast and ovarian cancer.
But given the elevated risk, what is the best way to screen patients like Estelle for breast cancer? “My doctor recommended that I have, in addition to mammograms and sonograms, which I was having all along annually, I now needed an MRI for the diagnosis,” says Estelle.

Now, new research in the latest New England Journal of Medicine shows that breast MRI is a much more sensitive test for women at the highest risk for breast cancer, those with the genes that predispose them to the disease. In other words, it detects many of the cancers mammography misses.

Previous studies have shown that mammography is not very sensitive in young women, those under 50, who are carriers of a BRCA genetic mutation. Perhaps this is because of the high rate of growth tumors in these women, or because the changes seen on mammograms are atypical.

In fact, the study found while mammography was only accurate a third of the time in detecting the presence of an invasive breast cancer, breast MRI is nearly 80 percent accurate. Also, MRI was able to detect cancers much smaller than those detected on mammography, and thus, presumably at an earlier, more curable stage.

A drawback of MRI screening is that MRI will generate more findings judged as uncertain. Screening by MRI in this study led to twice as many unneeded additional examinations as did mammography and three times as many unneeded biopsies.
Still many experts believe these downsides are outweighed by the ability of MRI to detect early breast cancers in high risk women. Dr. Mark Novick is a radiologist with Manhattan East Breast Imaging. He says, “Clearly any women at high risk should be getting breast MRI in addition to mammography and ultrasonography.

Estelle is glad she did. She had a normal MRI, then just three months later, there was a tiny spot, so small that mammography and ultrasound missed it. It was biopsied and turned out to be cancer, caught in time! According to the authors, women with positive genetic markers, in New York and other cities, should be getting breast MRI and starting their screenings 5-10 years earlier then the general public. But breast MRI is not covered by insurance in most cases, so its often up to the woman to pay for this test which costs also, so that these aggressive cancers can be found at the earliest possible stage and treated aggressively with the best chance for care.

“Getting breast cancer is not a lucky things but I am lucky because I caught it early and I know that I’ll be alright,” exclaims Estelle.

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