This news release describes preliminary results of a study in 195 women with dense breast tissue subsequently having cancers detected from an abbreviated breast MRI after screening negative with a mammogram. The release states that this type of screening has a much higher rate of cancer detection than mammography or 3D mammography. The release also emphasizes that abbreviated breast MRI might be better than current supplemental screening of whole breast screening ultrasound which appears to have a high rate of false positives. Unfortunately, the release doesn’t say what the rate of false positives are with abbreviated MRI.
The study was presented at the Radiological Society of North America (RSNA) annual meeting and to our knowledge has not been published. A request for a copy of the study abstract went unanswered.
This release throws yet another iron into the fire of mammography screening. Because of recent media attention relating to problems with mammography screening for women with dense breasts and because 30 states require that women receive a letter after screening informing them of their breast density, adding to women’s fear and anxiety about breast cancer, institutions should be even more careful when announcing results of a study that involves mammography screening and breast density.
There was no discussion of costs of the abbreviated breast MRI and it was unclear if this type of procedure is commonly covered by insurance for asymptomatic women.
The release also refers to women who “…request additional screening after a negative mammogram….” Requesting additional costly screening adds to overall healthcare costs and may also lead to over-diagnosis.
The release described better cancer detection rates using the abbreviated breast MRI compared with mammography and 3D mammography. Unfortunately, the release didn’t compare the cancer detection rate of the abbreviated breast MRI with whole breast screening ultrasound which is the current standard supplemental screening tool to use for women who are asymptomatic.
It remains unclear if the abbreviated breast MRI is better than ultrasound, the current standard of care.
While calling out ultrasound screening for having a high number of false positives, the release offers no details on the number of false-positives for abbreviated MRI screening.
Further, the release offers no information about the stage of the cancers diagnosed with abbreviated MRI. Readers deserve to know how many cancers identified in the study were ductal carcinoma in situ (DCIS). Many healthcare professionals believe DCIS should be re-named because this condition refers to abnormal cells inside a milk duct in the breast, is not invasive, and there’s a debate over whether it is breast cancer.
Although the study authors mentioned that whole breast screening ultrasound produces high rates of false positives, there was no information provided about the rate of false positives for the abbreviated breast MRI.
The findings are preliminary and there was no data presented that compared abbreviated breast MRI with whole breast ultrasound. The only evidence was the following quote:
“Based on the literature and our results, women with dense breast tissue who desire supplemental screening, these results suggest that AB-MR may be a better option than other supplemental screening test such as whole breast ultrasound.”
The release veers into disease mongering when it drops in the comment that “One in eight women in the United States will develop breast cancer at some point during their life.” That’s a jarring statistic that rarely fails to get attention. But to add perspective, consider what the National Cancer Institute notes about a woman’s lifetime risk of developing breast cancer: “a woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life. On the other hand, the chance that she will never have breast cancer is 87.6 percent, or about 7 in 8.” [Emphasis added.]
And as noted above, it would have been helpful if the release had stated how many cancers versus DCIS were found through the abbreviated MRI.
The release did not mention any source of funding for the study. Nor did it address whether there were any conflicts of interest among the researchers at the University of Pennsylvania.
The release compares the cancer detection rates of abbreviated breast MRI with mammography and digital tomosynthesis (DBT), or 3D mammography. However, it didn’t compare it with the most common screening alternative for these types of breasts — whole breast screening ultrasound — since as the release said, ultrasound carries “higher rates of false positives.”
As noted above, we wish the release would have noted the rate of false positives associated with abbreviated MRI screening.
There was no mention of the availability of abbreviated breast MRI.
It’s unclear how abbreviated breast MRI is different from full breast MRI. The difference is not explained in the release. It’s also unclear if the abbreviated breast MRI is novel for screening versus diagnostic testing.
The release didn’t appear to use unjustifiable language.