About half of women have dense breast tissue. Which can put them at double risk for breast cancer.
Dense breasts are not only a risk factor for cancer. But these glands and fibrous connective tissue make it difficult. To detect cancer on mammograms, the common method of breast cancer screening.
New research looks at other types of imaging that may be more effective for the 47%. Of women who have dense breasts with less fatty tissue.
Emerged as a viable alternative: breast MRI. Was superior to other methods using detection criteria.
The researchers also looked at hand-held breast ultrasound. Automated breast ultrasound and digital breast tomosynthesis.
All showed similar levels of effectiveness, study co-author Dr. said Vivian Freitas. An assistant professor at the University of Toronto and a staff radiologist. At the Joint Department of Medical Imaging, also in Toronto.
“I would say that those with dense breasts and negative mammograms are recommended. And should have complementary imaging procedures,” Freitas says. “That’s my first message to [patients who have dense breasts].”
Although studies have found MRI. To be superior in detecting cancer, Freitas urged patients. To discuss the pros and cons of each method with their healthcare providers.
Concerns about breast MRI include its availability and cost.
“Cost is actually our biggest barrier to widespread implementation of MRI,” Freitas said.
Screening mammograms are highly effective. for women with fatty breasts, detecting about 98% of cancers. Those with dense breasts may give false assurances.
Both dense tissue and breast cancer appear white on the image. making it harder to detect cancer in dense breasts, Freitas said.
On average, women have a 12% to 13% risk of developing breast cancer. A history of treated breast cancer or previous breast biopsies with. high-risk lesions increase the risk to intermediate.
High-risk patients, those with a lifetime risk of 20% or greater. Were not included in this study because MRI benefits. For them had already been established. To investigate the effectiveness of screening methods, researchers conducted. A meta-analysis of 22 studies in which more than 261,000 patients were screened for breast cancer.
The study included 10 that covered. Hand-held breast ultrasound; four in automated breast ultrasound. Three on breast MRI; and eight in digital breast tomosynthesis.
More than 132,000 women had dense breasts and a negative mammogram. The researchers found 541 undiagnosed cancers in that group. Breast MRI detects even small cancers.
Still, more research is needed, the researchers said. It is important to investigate. any effect of each procedure on the cost-effectiveness and mortality of breast MRI.
Susan Brown, managing director of the Susan G. Komen. Breast Cancer Institute in Dallas, reviewed the findings.
He noted that MRI technology is more. Sensitive but not very specific, which can lead to false positives.
Brown said he would like to see more research that the authors said was needed on the effects. of other screening methods on cancer survival.
“We don’t know if using breast MRI as a complementary screening to mammography. For average-risk women with dense breasts really saves lives.”
In the absence of clinical guidelines, Brown said. Follow-up screening decisions are a personal judgment call.
Komen’s policy focus has been on removing barriers to breast imaging, she said.
Although the Affordable Care Act has enabled widespread access to free screening mammograms. patients who must extra screening because of an inconclusive. Or abnormal mammogram may still face high out-of-pocket costs.
“Our position is that mammography is a step, an early step, in early detection. And alone is not capable of diagnosing breast cancer in every woman. And women with breast density are an example,” Brown said.
People who face high costs for diagnostic. And complementary imaging are less likely to have those tests. He said, citing past research.
“As a result, if they have breast cancer, a delay. In diagnosis may be associated with a much poorer outcome,” Brown said.
Nine states have waived cost-sharing for these follow-up tests, Brown said. Several others have introduced legislation this year to address the issue. Federal legislation may also be reintroduced later this year.
“To have that screening test but then not be able to follow up. if there’s an abnormality can have very negative consequences. Certainly for people who have cancer,” Brown said.
