Thursday, March 29, 2007

ACS Releases New Breast Cancer Screening Guidelines

Yesterday, the American Cancer Society (ACS) released new Breast Cancer screening guidelines for women who have a higher risk to develop the disease. Click HERE to read them. Why did they do this you may ask? In the adjacent picture you can see the mammogram on the left and an MRI on the right of the same patient. Obviously there is much better detail on the MRI. MRI is not being recommended to replace mammograms but rather to complement them. For example, calcifications will show on a mammogram but might not on an MRI. Often calcifications are indicative of a possible cancer. MRI's also have built in software programs that use sophisticated algorithms to detect probabilities of cancer in lesions identified.

I may have told this story before so if I have please forgive me. When Patty had a biopsy of an area in March at my urging, the doctor had said it wasn't necessary, there was a another very small area that was seen. It did not look like a breast cancer. It instead looked like a benign lymph node. It was also in a difficult location to biopsy without causing a lot of pain and misery (This is not the area where a cancer ultimately developed). The Radiologist said we could get an MRI but he didn't think it was necessary. Patty had just had two biopsies and didn't want to have to go through another procedure. My instinct and experience was to disagree and strongly suggest that it be done but, I was persuaded by her weariness and his experience. And, her risk over the next 5 years of developing breast cancer according to several risk assessment tools was ONLY 2%.

Worst mistake I've ever made. I regret not following my initial instinct and knowledge EVERY day and will for the rest of my life. If we had proceeded, the MRI would have most likely discovered both areas in their earliest stages.

I said all that to say, for the current time it is still going to be difficult to obtain a Breast MRI unless you meet certain criteria. See the criteria below:
  • have a BRCA1 or BRCA2 mutation
  • have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
  • lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
  • had radiation to the chest between the ages of 10 and 30
  • have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative
This is due to the cost of the exam. Mammograms are relatively cheap in the health care arena. MRI's are not. These new guidelines may or may not be followed by your insurance company. There is a risk calculator that will be used to help see if you qualify for a Breast MRI. I strongly urge every female reading this to click HERE and assess your risk. Men, have your wives assess their risk.

One thing to keep in mind is this. If you don't meet the criteria but your intuition gives you concern or the physician wants you to return in six months for a follow-up exam, insist on having a breast MRI even if your risk factors do not meet the requirements (see above). You may have to even pay for it yourself. At that point you'll have to ask yourself, how much is your health worth or your peace of mind? Tough question.

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