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MRIs prove effective in detecting breast cancer

MRI screenings can be more effective than traditional mammograms at finding breast cancer in women at high risk for the disease, Duke researchers found.

A recent study showed that women who underwent MRI screenings rather than mammograms were better situated for doctors to detect cases of cancer. Researchers compared two groups of 299 uninsured or underinsured women, one with general risk factors and the other with high-risk factors. The first received mammograms, and the latter underwent both digital mammograms and MRI screenings. The mammography screenings detected one case of breast cancer in the group, and the MRI screenings detected nine, according to preliminary findings presented at a Sept. 20 health disparities conference put on by the American Association for Cancer Research.

Still, the study is ongoing and needs greater numbers to be conclusive, said Dr. Anne Ford, the study’s lead author and assistant professor of obstetrics and gynecology at the Duke University School of Medicine.

“You can’t put too much weight into it yet, because we haven’t done a lot of statistical analysis,” Ford said. “The numbers are so small.”

One caveat to the data involves the cost of the MRI screenings. Due to a grant, the cost of a MRI was reduced from $3,500 to $649. Thus, the cost per diagnosis was cheaper for a MRI at $21,561 compared to a mammogram at $37,375.

Over a seven year period, Ford and her research team screened the two groups and then compared the cost-effectiveness of the screening methods.

Ford noted that calculating cost per diagnosis can be complicated. Before the study is published, Ford said she will be working with a health economist to refine the cost per diagnosis in the study, as well as determine the money saved by diagnosing high-risk women early.

Ford noted that many of the women in the high-risk group have the breast cancer gene mutation. All of the women considered high risk in the study had a 20 percent greater chance of developing breast cancer during their lifetimes, she added.

To gather participants in the Duke study, a group of “patient navigators” ventured into low-income areas in Durham, N.C. All of the women recruited for the study are from central North Carolina and have limited or no insurance, said Stephanie Robertson, patient navigator of the Women’s Wellness Clinic at Duke. One criteria for selection was women who were previously diagnosed or had a family history of breast cancer.

MRI screenings have a greater risk of false positive results due to their sensitivity, Ford said, adding that MRIs should not be used as a general screening tool in the way mammograms are currently used.

“MRIs are often misused for cancer screening,” she said. “They should really only be performed on women who are of very high risk for breast cancer.”

The study was made possible through a grant for screening underserved women from the Susan G. Komen Breast Cancer Foundation and continues today through the support of the Avon Foundation for Women, Robertson said.

Each of the study pools contained higher percentages of blacks than the general population, and the average risk pool included a higher percentage of Hispanic women than the population at large, according to the conference presentation.

Ford said patient navigators, such as Robertson, were an integral part of the study. Navigators served as advocates for patients, working with them on any issues or barriers—emotional, financial or otherwise—that they may face while being screened for cancer.

In addition, the patient navigators were integral in charting the women’s compliance with following up on the results. In the MRI screening group, 90 percent came back for follow-up screenings, while 75 percent in the mammography screening group followed up.

“The main thing that we do is try to address the barriers that women face that may prevent timely access to adequate breast health,” said Xiomara Boyce, a patient navigator who worked on the study.

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