October 5, 2006
Can MRI save lives?
High-tech scans help track down breast cancer in younger at-risk women when mammograms alone fail
"It's something I wanted to do at the amateur level," said Berlin, a San Dimas resident who competes in her own age group. "I feel like when I'm skating I can do anything. It makes anything else seem easy."
But Berlin's life became anything but easy beginning in April of that year. Her mother, Eleanor Tavris, who had survived a battle with stage-three breast cancer nine years earlier, was vigilant about monitoring the health of her three daughters. When a cancer seminar caught her attention, she invited Berlin to come along.
Tower Saint Johns Imaging:
S. Mark Taper Foundation Imaging Center:
City of Hope Department of Clinical Cancer Genetics:
Tower Hematology Oncology Medical Group:
Israel Cancer Research Fund Los Angeles
After listening to a presentation from a breast radiologist, Berlin began to worry that her annual mammogram and monthly self-exams might not be adequate enough to detect a tumor.
"I was concerned about my family history and that a percentage of malignancies are missed in mammograms," she said.
She underwent genetic screening and was relieved when her test for a cancer-causing genetic abnormality common among Ashkenazi women came back negative. But Berlin still wasn't convinced she was in the clear. She had been told she had dense breasts, which can obscure the detection of tumors in mammography and ultrasound screenings, and she wanted to be certain she was cancer-free.
Despite her family history of cancer, Berlin's insurance company initially fought her request for magnetic resonance imaging (MRI) of her breasts. MRI scans are expensive, ranging from $1,000 to $6,000.
After she challenged the carrier's decision and won approval for the procedure, Berlin scheduled her test in early April at Cedars-Sinai.
And, indeed, the MRI revealed an aggressive tumor growing inside of Berlin's right breast.
For young, high-risk women like Leslie Berlin, vigilant cancer screening can sometimes mean the difference between a lumpectomy and the loss of one or both breasts to mastectomy. But research is revealing that mammogram screenings by themselves are not a guarantee of catching breast cancer.
No method of detection is 100 percent effective. Mammograms are thought to be about 80 percent effective in women 65 and older, but the reliability drops to 54 percent in women under 40, according to the American Cancer Society's Guidelines for Breast Cancer Screening. Factor in dense breast tissue, which in itself is associated with a higher cancer risk, and the reliability of a mammogram drops further.
Breast cancer remains the second leading cause of death from cancer among American women, with lung cancer topping the list.
This year 213,000 women will be diagnosed with breast cancer in the United States, according to the National Cancer Institute (NCI), and 25 percent of women will be diagnosed with the disease in their lifetime. The NCI puts the breast cancer risk at 60 percent to 80 percent for women of Ashkenazi heritage with a family history of breast or ovarian cancer who also test positive for either the BRCA 1 or BRCA 2 gene mutations.
In addition, researchers believe there's a strong likelihood of as-yet-undiscovered genetic risk factors in the Ashkenazi population that could play a role in breast and ovarian cancer.
Experts recommend that women in such high-risk categories begin mammograms at age 30 or younger and at shorter intervals (e.g., every six months) in order to catch breast cancer in its earliest stages. And MRI is increasingly being recommended as a complimentary screening tool, especially to find invasive tumors, said Dr. Arnold Vinstein of Tower Saint John's Imaging in Santa Monica.
Whereas film and digital mammography uses X-rays to detect changes in the breast and signs abnormalities, MRI finds abnormal tissue by using magnetic fields to measure the reaction of hydrogen atoms in the body.
Recent studies have backed up the reliability of MRI, which has been shown to catch developing tumors that can be missed in traditional mammography. Its accuracy is generally considered to be 90 percent.
With more doctors recommending MRI scans, the S. Mark Taper Foundation Imaging Center at Cedars-Sinai has seen patient numbers jump from a couple every month to five per day over the last five years, said Dr. Rola Saouaf, chief of the center's body and cardiovascular section.
Despite the substantially higher cost of MRI, women like Berlin say the peace of mind is worth the expense.
Without the scan, Berlin believes, "they never would have detected it. I had mammograms every year and it never showed up. My oncologist told me if I didn't have it treated, I'd have had four years to live."
Medical professionals began turning to MRI for breast cancer 10 years ago, and its use has blossomed in the last five years. In July 2004, a landmark study in the New England Journal of Medicine confirmed that MRI is more sensitive than mammography when it comes to detecting tumors in women with an inherited susceptibility to breast cancer.
Cedars-Sinai's Saouaf said she was skeptical of the technology when she started at the hospital five years ago.
"I thought there would be too many false positives," she said, "but I've picked up a lot of tumors."
Saouaf said one of the drawbacks at first was that MRI couldn't always distinguish between cancer and a benign condition, like fibrocystic breast disease. Now a staunch supporter, she said the technology is improving and the scans are increasingly able to determine such differences.
During the procedure, women lie chest down on a movable bed with their breasts inside two coil-lined cylinders, which emit the radiofrequencies. The bed slides into a tube at the center of a 7-by-7-foot cube, and as the machine prepares to scan it emits a noise many patients have described as a rapid hammering or thumping. Labs will often provide patients with personal stereos to help cut down on the noise, as well as sedatives for those who experience anxiety or claustrophobia.