By: Barry W. Ramo, MD
- Cardiologist, New Mexico Heart Institute
- Clinical Professor of Medicine and Emergency Medicine, University of New Mexico School of Medicine
- Consulting Professor of Medicine, Duke University School of Medicine
Q: I understand there is a better way to detect breast cancer than with a mammogram. I have had two mammograms in the past five years and both required biopsies, which turned out negative. What new tests are available?
A: For women who aren’t at unusual risk of developing breast cancer, the standard recommendation is to have an annual mammogram after age 40, be examined by a professional on a yearly basis and do a self-examination monthly.
Mammograms, which are X-rays of the breasts, aren’t perfect. They can detect breast cancer in its earliest stages, but they also can miss tumors, particularly in dense breasts. And, yes, there is a false-positive rate. But there isn’t a more accurate test if you are an individual at normal risk for breast cancer.
During the past several years, ongoing studies have looked at magnetic resonance imaging, which is different from mammography in that it doesn’t require X-rays.
Experience with it is limited but two recent studies suggest that in high-risk patients, it is the test of choice. It can detect cancer that can’t be seen any other way.
In one group of high-risk women, MRI detected 80 percent of cancers whereas mammograms detected 30 percent. The second study looked at another high-risk group of women — those who carry a genetic abnormality called BRAC1 and 2. The researchers looked at nearly 300 women for six years with annual screenings using MRI, ultrasound, standard mammograms and examination by medical professionals.
In a report in the Journal of the American Medical Association, the researchers found 17 cancers had been detected by MRI, whereas half as many were detected by ultrasound or standard mammography.
The problem is that MRI detects shadows that look like cancer but turn out not to be when biopsied — in other words, false-positives.
So the testing wouldn’t be good for you. But if you are in the high-risk group, the false-positive rate will be lower.
If you have questions for Dr. Barry Ramo, you can submit them to firstname.lastname@example.org