Cancer History Should Consider MRI: Study

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Although the story acknowledges that women may need to pay for such imaging out of their own pockets, it does not provide any estimate of the cost… which may run more than $1000 per MRI scan. And since such testing is rarely a one-time event… women who choose to have MRI scans that are not covered by their health care insurance may spend thousands of dollars.

One estimate of the cost of MRI for women at an extremely high (50%) risk of developing breast cancer concluded that more than $50,000 was spent for each cancer found.

According to the abstract of this study, cancers were found in 3 percent of the women with a history of breast cancer, which means that about 33 women were scanned for each cancer found, so the scanning cost would be somewhat more than $30,000 for each cancer found. And since conventional mammography was not part of this study, the researchers cannot claim that MRI found any tumors that would not have been found by conventional mammography, so there is no way to conclude from this data that there was any incremental advantage to adding MRI.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

As noted above, the story reports that this study indicates women who have had breast cancer could benefit from annual MRI scanning. But since the women in the study had just one scan, not a series of scans over time, it does not appear to be able to evaluate the potential benefits of annual scans.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story dismisses the potential harms of adding MRI scans. It paraphrases an expert as saying there is no downside to getting an MRI, “except perhaps an increased risk of false positives and perhaps a need to pay out of pocket.” As noted above, the out of pocket costs of ongoing scanning could cost a woman thousands of dollars. The researchers reported that 9 percent of the women with a history of breast cancer underwent biopsies following their MRI scans. Two out of three of those women were found to not have cancer. The story should have been more clear about this false positive rate.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

This story misrepresents a study comparing two groups of women who had one-time MRI scans of their breasts as being a study that looked at whether annual MRI scanning is superior to conventional mammography (which wasn’t even part of the study).

In addition, as noted above, there is very little information in the story about who was included in this study; including why they were given MRI scans of their breasts even though such scans are not routinely recommended. The story should have made clear whether these women represent the general population of women who have had breast cancer or whether there was something specific about their situations that led them to have MRI scans.

Does the story commit disease-mongering?

Not Satisfactory

The story does say that the American Cancer Society does not currently recommend MRI scans for most women with a history of breast cancer. However, it does not give readers the information they need to understand who this study is relevant to. It does not provide key details about the women who participated in the study. Was there something unusal about their cases that prompted them to get an MRI scan of their breasts? The researchers reported that 3 percent of the women with a personal history of breast cancer were found to have another tumor. That number seems quite high. The story should have told readers more about the women in the study and how they compare to the average woman who has had treatment for breast cancer. And again, it should not allow researchers to claim that MRI adds anything to conventional mammography when this study did not involve any such comparison.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

This story does include an independent source. However, it fails to report that the senior researcher involved with this study disclosed that she is a consultant to a manufacturer of MRI scanners and that another researcher has received grant support from the MRI scanner company.

Reference:
Meeting abstract disclosures
http://rsna2010.rsna.org/program/event_display.cfm?em_id=9006996

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Although the story does say that MRI scanning would be used in conjunction with conventional mammography, it does not include any discussion of the relative merits. Indeed, the study did not appear to include any comparison of MRI scans to conventional mammography that would provide any insight to whether the combination of scanning methods might be superior to conventional mammography alone.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story does not address the availability of appropriate equipment and skilled operators and radiologists. The story should have pointed out that MRI imaging available to women in general may not match the quality of the work done in this research study.