On March 28, 2007, the American Cancer Society issued new guidelines for using MRI scans in addition to annual mammograms for women at high risk of developing breast cancer (defined as a lifetime risk of 20 to 25 percent or greater).1 The new guidelines, however, should be interpreted with caution and do not apply to women at average risk for developing the disease. As with mammography, MRI screening has important limitations. In particular, because MRIs are more sensitive than mammograms, they are more likely to show spots that are not cancer (a false positive result), leading to unnecessary biopsies and increased fear and anxiety.
In a separate study that appeared in the April 3, 2007, edition of the Annals of Internal Medicine,the American College of Physicians challenged the recommendation that all 40- to 49-year-old women be screened annually for breast cancer.2 Instead, the prominent physicians’ group suggests tailoring the decision to the individual woman on the basis of her risk of developing the disease and her concerns about mammography, noting that clinicians should inform women about the potential benefits and limitations of screening mammography.
A study published in the April 5, 2007, edition of the New England Journal of Medicine, studied the effectiveness of computer-aided detection (CAD) in assisting radiologists to identify suspicious findings on a mammogram.3 Researchers found that CAD actually reduced the accuracy of interpreting mammograms, leading to more false positive results and an increased rate of biopsies. This study highlights problems that are emerging with a technology that was approved and marketed before its usefulness was established.
BCA continues to encourage clinicians to provide information about the benefits and limitations of screening technologies so women can make informed decisions about them (see BCA’s “Policy on Breast Cancer Screening and Early Detection.”
1 Debbie Saslow, et al., “American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography,” CA Cancer J Clin 57(2), March/April 2007, pp. 75-89.
2 Amir Qaseem, et al., “Screening Mammography for Women 40 to 49 Years of Age: A Clinical Practice Guideline From the American College of Physicians,” Annals of Internal Medicine 146(7), April 3, 2007, pp. 511-515.
3 Joshua Fenton, et al., “Influence of Computer Aided-Detection on Performance of Screening Mammography,” New England Journal of Medicine 356(14), April 5, 2007, pp. 1399-1409.