MRI and Mammograms

[RobinP]

Besides seeing calcifications, why are mammograms not just replaced with MRIs since MRIs are more sensitive on bc detection and safer in terms of not causing radiation exposure?I think this has something to do with not enough clinical trials on MRIs on bc detectioin. What do others think?
By the way, I advocate digital mammos over film due to to less radiation exposure with digital and ability to enhance images without retake exposure to radiation.

[AlaskaAngel]

Inertia and $.

1. Most places have the mammo equipment and the techs have been trained for doing mammos, so when something is in place they tend to keep it until there is enough ruckus raised to make a change.

2. You can process quite a few people through a department in less time than it takes to process people using an MRI, so depending on the $ available you can end up either processing more women at least with something like a mammogram or do MRIs and have less women getting any kind of imaging.

3. The only reason there has been more emphasis on changing over to MRI's is because the calcifications stand more often to be missed for women with dense breasts. (But my guess is that they will find that MRIs are also going to be better for catching more of those less common breast cancers that aren't detected by microcalcifications anyway).

A.A.

[RobinP]

Thanks, AA, I agree that the safer, more effective, but more costly bc detection method is MRI. I truly think I will opt for breast MRI and no mammo this year for screening.

[CLTann]

I believe it is purely a cost factor. MRI will run around 3 to 5 grands while mammo around a few hundred dollars.

[Lani]

There are many radiologists trained to read mammograms, but few with much experience reading breast MRIs. Hopefully this will change with time.

[AlaskaAngel]

A diagnostic device that resembles a mammography unit can detect breast tumors as tiny as one-fifth of an inch in diameter, which may make it a valuable complementary imaging technique to mammography, say researchers at Mayo Clinic, who helped develop the technology along with industry collaborators Gamma Medica and GE Healthcare.

This new technique, Molecular Breast Imaging, uses a new dual-head gamma camera system and is sensitive enough to detect tumors less than 10 millimeters (about two-fifths of an inch) in diameter in 88 percent of cases where it is used. Early findings from an ongoing comparison of the device with mammography show that it can detect small cancers that were not found with mammography, say the investigators. Mayo Clinic physicist Michael O'Connor, Ph.D., will present these results Saturday, Dec. 16, at the 2006 meeting of the San Antonio Breast Cancer Symposium.

"Our ultimate goal is to detect small cancers that may be inconspicuous or invisible on a mammogram for high-risk women with dense breasts," says Dr. O'Connor.

The scientists also say their device will likely be only slightly more expensive to use than mammography, and will be much more comfortable for women because much less pressure is needed to image a breast.

"We hope that our studies will eventually show our device to be almost as sensitive as magnetic resonance imaging (MRI), which is probably the best diagnostic test available to date, but is not widely used because of its expense," says Stephen Phillips, M.D., a Mayo radiologist and a study co-author. An MRI scan costs as much as ten times more than a traditional mammogram and involves injection of a contrast agent.........

http://medicineworld.org/blogs/breast-cancer/breast-cancer-blog.html

[RobinP]

Thanks, AA, for the information on MRI and the link, which was very interesting and informative.

[mts]

I can't say I am an expert, but I "sit" on a Congressionally Directed Medical Research Panel. Last year, I attended the panel and sat with 15 scientists and reviewed applications for federal funds from nationally recognized research centers and teaching hospitals (Loma Linda, UPenn, Boston, MD Anderson to name a few) We reviewed 68 applications from the technology side of breast cancer and EVERY ONE of the applications began their narrative with words similar to the following:

"Because mammograms are obsolete, we are investigating a new method
to detect tumors via ...blah, blah, blah."

The scientists that sat in the room were mostly Ph D's in physics that either teach or perform research at nationally recognized cancer institutions... and these are THE people that invent and improve the technology out there for cancer detection.
Anyway, the bottom line is that mammograms have been the work-horse for breast cancer detection because for the longest time, there was nothing else. Also, mammos provide an inexpensive, portable capability that can be used in underserved areas (rural) as well as third world settings. The idea that the mammo is better than nothing has been used enough !
In the end, the panel approved funding for about 15 of the 68 applicants. Of the 15, only 2 ranked high enough to be innovative technology that will dramatically improve the detection of breast cancer. One of those had an MRI- soundwave, lightwave component that attached to a mammo machine and cost less than $300,000. Therefore allowing all the current centers using mammos to incorporate the new technology to their existing machines...
I do believe that MRI's are without a doubt a very important part of breast cancer detection- and yes, the cost is so high that many oncs don't prescribe it or own one. So, in the meantime, we have to be more informed than ever and do what most of us already have- get the information, become our own advocates and support sites like this one.

Maria (MTS)

[AlaskaAngel]

Thanks for sharing that, Maria. It helps to understand that there are those who are working on better solutions and who also do understand the limitations of mammography. As was initially noted with the question raised with this thread, "Besides seeing calcifications" why are mammos not replaced with MRIs. Mammograms are still useful for those with breasts that are not so dense as to hide the calcifications although not those whose cancer isn't represented with calcifications.

However, from a different thread on this board it appeared to me that a fairly high percentage of those on this board who responded had cancers that were not detected by calcifications.

Was there any rationale presented in the discussions about mammography and other technology as to why, when the people who work in the radiology departments are protected by lead shields and are given badges to keep tabs on how much radiation they are exposed to, there is no effort made to provide patients with badges to track their total exposure over time? Nor is there any notation on each procedure report to indicate how much prior radiation the patient has had. Thank you so much for all your efforts in everyone's behalf.


AlaskaAngel

P.S. From article discussing new imaging gamma camera,

http://www.medicalnewstoday.com/medicalnews.php?newsid=59281

"Mammography uses low-dose X-rays (ionizing radiation) to create images of the anatomy of breast tissue. If the breasts are very dense, it can only accurately help in tumor diagnosis in 30 to 50 percent of cases, says Deborah Rhodes, M.D., another study co-author. Yet women who have dense breasts are four to six times more likely to develop breast cancer, and more functioning breast tissue is available in which disease can occur, she says."