Mammography MR vs X-ray

Read tis excelent review advocating the use of X-Ray mammography over MRI and the situations where the reverse is warranted. This review is by Dr. Subhash Ramani, Addl. Prof. of Radiology at Tata Memorial Hospital.

Read on:-

Hi Folks,

I have been reading the recent reports on Breast MRI better etc, etc in News paper to which I have send an appropriate letter!

I recently came across the write up in - Inner Spaces.

I would like to put things in correct perspective:

The American Cancer Society guidelines Published in the March/April 2007 available at CA: A Cancer Journal of Clinicians specifies that breast MRI screening should only be used with certain groups of high-risk women, such as BRCA mutation carriers and those with a family history of breast cancer. The guidelines do not recommend MR for women at average risk, those with very dense breasts, or those who already have had breast cancer, including ductal carcinoma in situ (DCIS). The ACS Breast Cancer Advisory Group said there is not enough evidence to support MR in this population because of the modality's tendency toward false-positive results.

The ACS also says that breast MRI should be used with conventional mammography as part of an annual screening regimen in certain groups of women. The other article published in the New England Journal of Medicine March 29, found that breast MRI had good sensitivity, specificity, and negative predictive value, and in some cases detected contra lateral breast cancer that was missed with mammography and clinical examination. In a related editorial, Dr. Robert A. Smith, from the American Cancer Society in Atlanta, comments that it may be argued that the added sensitivity of MRI of the contra lateral breast comes at high cost in terms of false-positive results and over diagnosis.

There is no organized breast cancer screening program in India . Screening mammography needs extensive quality assurance and controls at various levels, which is lacking in India. It is only since the last few years that AERB(India) has made it mandatory to have all mammography units to be prototype approved!

None of the professional organizations that advocate Screening mammography support sonography for screening like American College of Radiology, & FDA.

There are anecdotal reports of breast sonography picking up additional cancers not detected by mammography, and such statements/ claims about the effectiveness of breast sonography - breast screening - are not supported by the medical literature. While anecdotal evidence supports the effectiveness of finding additional cancers by breast sonography, clinical studies have failed to support such claims!

All alternative breast imaging modalities are insufficient for detecting cancer and are not a viable replacement for biopsy, according to a report(2006)released by the Agency for Healthcare Research and Quality (AHRQ). AHRQ is a division of the U.S. Department of Health and Human Services.

Each of the four (non invasive) tests -- magnetic resonance imaging, ultra sonography, PET, and scinti mammography -- would miss a significant number of cases of cancer, for women who receive abnormal findings from a mammogram or physical exam.

All four tests would miss between 4% to 9% of cancers among women with an abnormal mammogram & biopsy remained the most effective technique for revealing any potential for cancer.

Regards

--
Dr Subhash K Ramani.
Additional Professor & Asst Radiologist.
(Resource Person Mammography)
Tata Memorial Hospital.
Dr E Borges Raod, Parel,
Mumbai 400012.India.
Tel: 24171761(Off).
Fax: 009122-24146937