CodeBlueBlog: BREAST MRI: THE GENIE IN THE BOTTLE

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MRI's are better than mammography at finding breast cancer. In a recent study of high risk women, of 22 breast cancers detected, 17 were found by MRI, but only 8 were found by conventional mammography.

For the physicians and scientists out there, MRI's sensitivity was 77% compared to 36% for mammography in this particular cohort.

This study was done with women who are at substantially higher risk (those with BRCA1 and 2), but everyone in the field of breast MRI KNOWS that MRI is more sensitive than mammography across the board. Period.

So why don't we just use screening MRI instead of mammography? Well, there are good reasons. MRI is expensive, and it finds a lot of things that AREN'T cancer and that would lead to biopsies. Besides, it is hard enough to get mass screening done with plain film mammography...getting every woman in every year for a high-field, contrast-enhanced bilateral MRI of the breasts is a mind-boggling proposition...

Further, MRI of the breast costs $800-$1000, whereas mammography runs about $125.00-$150.00.

Finally, all the data are not yet in. Before we initiate massive screening programs that cost tens of millions of dollars every year, we need to know conclusively that screening with MRI would translate into a decrease in breast cancer mortality.

(But you know what...we didn't wait for similar statistical and epidemiological clearance before recommending yearly plain film mammography!)

I'm not saying that we should begin advocating mass screening MRI's for breast cancer; however, I do believe that every single woman who is having a mammogram should understand that there is a more sensitive examination out there.

And then THAT WOMAN should decide if her resources are well spent on an MRI of the breast, given the risk-reward ratio, given the incomplete data, given the state-of-the-art, and given the possibilities of a false-positive result.

There is VERY LITTLE WAY for a woman to make this decision under the current insurance system; and there would be NO WAY AT ALL to choose this option (or any option) under a nationalized (or single payer, or Canadian) type health care system.

The genie in the bottle is not MRI, it's choice.

If we opt for more government control, more Kerry-Clinton like solutions, we will have less control over our health care decisions.

If we embrace Medical Savings Accounts, we will have a say.

Then a woman can look at these issues, evaluate these data and say: I CHOOSE TO HAVE SCREENING BREAST MRI EVERY YEAR.

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health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

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