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John W. Mitchell, Senior Correspondent | July 16, 2018
From the July 2018 issue of HealthCare Business News magazine
It’s well known that mammography is the first line of defense when it comes to diagnosing breast cancer, but there is mounting evidence that contrast-enhanced breast MR can be a highly valuable secondary screening option for high-risk patients. HealthCare Business News spoke to experts in order to figure out how MR fits into the breast cancer screening conversation, and what its role will be in the future.
“I don’t think women know that this is the Royals Royce of breast cancer screenings – it hasn’t percolated,” said Dr. Elizabeth Morris, chief of breast imaging services and Larry Norton Chair at Memorial Sloan Kettering Cancer Center. “Physicians don’t know about it, either…there’s definitely an underutilization of MR.” She cited a recent U.S. study that found only about one percent of women who qualified for secondary breast screening due to higher risk factors were getting the exam.
Another study, published in the March issue of Journal of General Internal Medicine, concluded that, “Comparatively little is known about the use of [breast] screening MR in community practice," and "Utilization of screening MR in a community setting is not consistent with current professional guidelines and the goal of delivery of high-value care."
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“As an organization, we are eager, but disciplined, to learn from published studies more about who is most likely to benefit from breast MR screening,” said Susan Brown, MS, RN, senior director of Education and Patient Support at Susan G. Komen, a nonprofit breast cancer awareness organization. “Individuals, however, can consult with their providers, who most likely base recommendations on clinical practice guidelines but also on professional judgment and discussion with their patients.”
The American College of Radiology (ACR) and the Society for Breast Imaging (SBI) have both put forth new MR contrast guidelines for women at higher risk for developing breast cancer. In a joint announcement in April, the ACR and the SBI assigned "special status" to African-American women, as well as women who have risk factors putting them at higher risk of breast cancer. This includes: a calculated lifetime risk of 20 percent or more, those who have received mantle radiation therapy at a young age, women who have previously been diagnosed with breast cancer by age 50, and women with dense breast tissue.
