American Cancer Society issues recommendation on MRI for breast cancer screening

December 08, 2015

The panel reviewed new evidence that has become available since the Society last issued guidelines for the early detection of breast cancer, in 2003, at which time there was insufficient evidence to justify a recommendation to use MRI to screen for breast cancer. Newer data provided the opportunity for the panel to make specific recommendations. The panel says in addition to mammography, annual screening using MRI is recommended for women who: have a BRCA 1 or 2 mutation have a first-degree relative with a BRCA 1 or 2 mutation and are untested have a lifetime risk of breast cancer of 20-25 percent or more using standard risk assessment models received radiation treatment to the chest between ages 10 and 30, such as for Hodgkin Disease carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni syndrome and Cowden and Bannayan-Riley-Ruvalcaba syndromes).

The panel also identified several risk subgroups for which the available data are insufficient to recommend either for or against screening. They include women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. The panel acknowledged that these clinical factors are relevant in making individualized decisions about MRI screening when family history alone does not predict a risk of approximately 20 to 25 percent.

The complete guideline is published in the March/April 2007 issue of CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society.

"As with other cancer screening tests, MRI is not perfect and in fact leads to many more false positive results than mammography" said Christy A. Russell, MD, co-director of the University of Southern California/Norris Cancer Hospital Lee Breast Center, and chair of the American Cancer Society's Breast Cancer Advisory Group. "Those false positives, which can lead to a high number of avoidable biopsies, can create fear, anxiety, and adverse health effects, making it imperative to carefully select those women who should be screened using this technology. These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than mammography alone."

Article: 'American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography,' (CA Cancer J Clin 2007;57:75-89.)

CA: A Cancer Journal for Clinicians is a peer-reviewed journal of the American Cancer Society providing cancer care professionals with up-to-date information on all aspects of cancer diagnosis, treatment, and prevention. Published six times per year, CA is the most widely circulated oncology journal in the world, mailing to approximately 90,000 individuals, including primary care physicians; medical, surgical, and radiation oncologists; nurses; other health care and public health professionals; and students in various health care fields. CA is published for the American Cancer Society by Lippincott Williams & Wilkins.

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In addition, the team discovered that the overall percentage of women in all the age groups not receiving steroid receptor tests was high at 41%, which resulted in treatment decisions being taken without this fundamental information. Three quarters of the patients who did not receive steroid receptor tests were given the hormone therapy, tamoxifen: that is, prescribed a treatment without evidence that it would work.

In a survey of UK breast cancer surgeons in 2004, 75% reported that they would treat older breast cancer patients in a similar way to younger patients and 98% responded that the cut off point for breast cancer surgery was not age related.

Dr Lavelle says: "Clearly there is a difference in clinicians' perceptions of how older breast cancer patients should be treated and their actual practice.

"Standard management of breast cancer was infrequent in older women in Greater Manchester. The lack of diagnostic and steroid receptor testing resulted in older cancer patients having no effective treatment with 41% not undergoing a steroid receptor test, 32% of whom received tamoxifen as their sole form of treatment.

"Mortality of elderly breast cancer patients is unlikely to improve where this pattern of management persists."

Research lead for the School of Nursing, Midwifery and Social Work, Professor Chris Todd, commented: "It would be wrong to conclude that ageism is to be found in the NHS on the basis of these results alone, as this study has not been able to take the preferences of older women themselves into account. This is something we intend to investigate in the next phase of our research."

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