--------------------------------------------------------------------------------

July 29, 2004
Study Shows M.R.I. Scans Are Better Finding Tumors
By THE ASSOCIATED PRESS

y The Associated Press

In women at high risk of breast cancer, new research suggests that
M.R.I. scans find nearly twice as many tumors as mammograms do, but
that they cost a lot and trigger more unneeded biopsies.

Ordinary mammograms are still recommended for screening most women,
starting at age 50. But the benefit of better detection from M.R.I.,
or magnetic resonance imaging, may outweigh its drawbacks for those
with a strong family history of breast cancer or faulty genes.

M.R.I. may also make monitoring a less dangerous option for women who
choose it instead of having their healthy breasts and ovaries removed
as a preventive measure.

"Women who are at high risk should consider getting M.R.I. besides
mammography," said Dr. Stephen Feig, a radiology professor at Mount
Sinai School of Medicine in New York and past president of the Society
of Breast Imaging.

Dr. Feig had no role in the study, which was conducted by doctors at
six cancer centers throughout the Netherlands and was partly financed
by the Dutch Health Insurance Council. Results were reported in The
New England Journal of Medicine.

The value of mammograms for women at average risk of breast cancer has
been hotly debated, though most doctors agree that the test saves
lives in women older than 50. The new study involved women with a
higher than average risk, such as those with a faulty gene or a mother
or sister who had breast cancer. For them, screening is less
controversial.

Researchers studied 1,909 Dutch women including 358 with one of the
BRCA genes or other mutations that predispose women to breast cancer.
Up to half of such women get it by the time they are 50, and they are
also prone to ovarian cancer.

They can cut their risk of cancer and death by having their breasts or
ovaries removed, or by taking estrogen-blocking drugs. But many do not
want such drastic measures.

Researchers compared mammograms, which are breast X-rays, to M.R.I.
scans, which use magnets to make detailed images without radiation. An
M.R.I. scan costs $700 to $1,000 - about 10 times the cost of a
mammogram. Women were screened three ways: a breast exam by a doctor
every six months, annual mammograms and annual M.R.I. scans.

After an average of nearly three years, 51 breast cancers had been
identified. Some results were excluded for various reasons. Of the
remaining 45 tumors, 32 were identified by M.R.I., including 22 that
had not been visible on mammograms. Only 18 of the 45 tumors were
caught by mammograms, a lower rate than studies typically show, some
experts noted. In the United States, mammography is thought to miss 15
percent to 25 percent of cases.

Still, experts acknowledged that M.R.I. was superior at detection. But
the scans gave more false alarms.