The Miracle of Breast MR Imaging — MSRT44
D. A. Strahle, M.D.
- Explain the role dense fibroglandular tissue plays in hiding breast cancer
- List four advantages screening breast MR imaging has over screening mammograms
- Discuss how often screening breast MR images should be obtained on a routine basis in women with dense breast tissue
- Discuss the potential of a national MR screening program to save lives and reduce costs
- Identify eight financial advantages for insurance carriers who pay for annual screening breast MR exams
Mammograms have been the only screening imaging modality accepted for early detection of breast cancer for almost 50 years. Historically, breast MR imaging has been used to define the extent of breast cancer only after identification by mammograms.
Our research used breast MR imaging to determine the presence of occult cancers missed by screening mammograms and the relationship of those cancers to dense breast tissue. In addition, we were able to identify a limited number of MR imaging sequences that are now being used for annual screening of women who have dense breasts without any other breast abnormalities.
For two years, 671 women received a breast MR exam at no cost following a negative screening mammogram. Eighteen parameters were recorded, including the density of the fibroglandular tissue and the location of any lesions inside or outside the fibroglandular tissue.
Numerous lesions (benign and malignant) missed by mammography were clearly identified by MR imaging. MR detected cancer at a rate of 16.3 per 1,000 women vs. the mammogram detection rate of 2.7 per 1,000 women. This correlates to a major shift in time of cancer detection, occurring six years earlier compared with mammography screening of the same women.
Only three different MR imaging sequences detected all the cancers, reducing scan time to only 12 minutes. Further, we were able to reduce unnecessary biopsies significantly compared with mammography.
As a result of our research, effective Nov. 18, 2013, the first insurance carrier in the nation began paying for annual screening breast MR exams for all women with dense breast tissue aged 40 to 80 years. They have estimated significant savings across eight major financial categories. In addition, the number of lives saved because of early detection is expected to be high, resulting in a major marketing advantage for the insurance industry.