Industry ponders cancer society's breast MRI guidelines

NATIONAL REPORTS-Recent cancer society guidelines and a national study urging breast magnetic resonance imaging (MRI) scans for high-risk women could prove to be influential in the industry.

The American Cancer Society (ACS) is advising certain women with an especially high risk of developing breast cancer to get MRIs along with their yearly mammograms. ACS says the two tests together give doctors a better chance of finding breast cancer early in these women, when it is easier to treat and the chance of survival is greatest.

At the same time, the New England Journal of Medicine released a national study that suggests women who have cancer diagnosed in one breast should get an MRI in the other.

With newly diagnosed cases, however, the data may already be in. According to Rebecca Stough, MD, a radiologist, and director of imaging at Mercy Women's Center and clinical director of Breast MRI of Oklahoma LLC, the proof for new cases is in the numbers.

"At Mercy Women's Center and Breast MRI of Oklahoma, we've performed almost 700 breast MRIs on newly diagnosed breast care patients since 2002," Dr. Stough says. "Nearly all of our newly diagnosed breast cancer patients have a breast MRI before any operations. It's the standard of care at Mercy. Our own numbers mimic what was recently stated in the New England Journal of Medicine, and we agree with the American Cancer Society new guidelines. In our patients, we found 3.6% unsuspected contralateral [opposite breast] breast cancers. In addition, we found 7.4% additional cancers in the same breast remote from the newly diagnosed cancers [multi-centric]."

High-quality breast MRI accurately maps the true extent of a breast cancer so that all of the cancer can be removed the first time, says Dr. Stough. "Consequently, at Mercy, the return to the operating room for positive margins in patients who have had preoperative breast MRI is 5.6%. Nationally, the average is approximately 27%. This is a huge cost savings to the insurance carriers because they don't have to pay for additional returns to the operating room in order to obtain clear margins. For patients, the accuracy of an MRI means they don't have to go through the anxiety of a second or third surgery in order to remove remaining cancers."

With breast MRI at Mercy, not only are the newly diagnosed breast cancer patients getting the correct surgery the first time, says Dr. Stough, but in addition, "patients with a past history of breast cancer who have periodic MRIs are being diagnosed with reoccurrence at a much earlier, often pre-invasive stage rather than the larger invasive, higher-grade stage that is usually seen. The highest cost to the insurance carriers is in patients with late-stage disease who require high-dose chemotherapy."

By far, Dr. Stough concludes, breast MRI is the most sensitive test. "It leads to diagnosis and treatment at the earliest stages rather than a later stage that is more expensive, not only in lives, but in healthcare dollars as well," she says.