More on screening MRIs for breast cancer. JAMA released a study examining screening MRIs for patients with the BRCA1 and BRCA2 gene mutation (those who have this mutation have an 85 percent lifetime risk of developing breast cancer):
“This study of 236 BRCA1 and BRCA2 mutation carriers demonstrates that the addition of annual MRI and ultrasound to mammography and CBE significantly improves the sensitivity of surveillance for detecting early breast cancers,” the authors write. “. . . our results support the position that MRI-based screening is likely to become the cornerstone of breast cancer surveillance for BRCA1 and BRCA2 mutation carriers, but it is necessary to demonstrate that this surveillance tool lowers breast cancer mortality before it can be recommended for general use.“
Note that the BRCA gene mutations are rare – occurring in 0.1 percent of the population, 2 percent in women of Ashkenazi Jewish (Eastern European) descent. And yes, there are misleading headlines, and it should be emphasized that this study only applies to this high-risk population.
Medpundit weighs in with questions about the implications of screening MRIs – most notably the effects of false positives and the unknown impact on survival.
CodeBlueBlog also discusses this study, taking a more economic slant. With the advent of Health Savings Accounts and the growing popularity of higher-deductible insurance, patients will be more empowered in their health decisions if they don’t agree with their physician’s recommendations or with clinical guidelines.
My take? Those with the BRCA gene mutation should certainly consider the screening MRI. For those without the mutation, the mammogram is still standard of care – and will continue to be the case until it can be studied that the screening breast MRI improves survival rate.
