MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
Women at high risk for breast cancer should get a yearly MRI in addition to their annual mammogram. This new recommendation from the American Cancer Society is raising a lot of questions for women with breast cancer in their families and women who have breast cancer themselves. The guidelines come at the same time as a new study that also recommends MRI or magnetic resonance imaging for some breast cancer patients.
Dr. Christy Russell is chair of the American Cancer Society's Breast Cancer Advisory Group and she's the co-author of the new guidelines. She joins us from Pasadena, California. Thanks for being with us.
Dr. CHRISTY RUSSELL (American Cancer Society): Thank you.
BLOCK: And Dr. Russell, we're talking about two things here. One is a study about MRIs detecting breast cancer and then these recommendations from the American Cancer Society. Let's talk about the study first. What did it conclude?
Dr. RUSSELL: The study concluded that when they looked at women with a new diagnosis of breast cancer in one breast, who'd had a normal physical examination and mammogram of the other breast - when they did an MRI of the other breast, they found that about three percent of the women had a diagnosis of cancer by MRI that had not been detected in any other way.
BLOCK: So they're saying along with mammogram, those patients should get an MRI?
Dr. RUSSELL: Correct. That would now account for about 200,000 additional women per year getting a one-time MRI around the time that they have their original diagnosis of breast cancer.
BLOCK: Okay. Now at the same time, the American Cancer Society has updated its guidelines for breast cancer screening. And what are you recommending now?
Dr. RUSSELL: We're recommending that for women who are really extraordinarily high risk of developing breast cancer in their lifetime, that in addition to annual mammography, they also have an annual MRI performed of both breasts.
BLOCK: Who's included in that group?
Dr. RUSSELL: Well, we're looking at women who are known carriers of the two breast cancer mutations that are easily testable, which are called the BRCA 1 or BRCA 2 genes. And for women who are first-degree relatives of someone with one of those gene abnormalities but has not yet been tested. Or a woman with a significant family history, who by a breast-cancer risk model, would have a lifetime risk of somewhere between 20 and 25 percent chance of getting breast cancer.
BLOCK: Well, how many women would be included in those high-risk groups that you're talking about?
Dr. RUSSELL: Perhaps a million or a million-and-a-half women right now would fall into this high risk group.
BLOCK: Would there be enough MRI machines, MRI centers, trained radiologists to perform all those new screenings?
Dr. RUSSELL: Probably not at this point. But it does get to the point that not all million women are going to be informed that they do sit in this very high-risk group. And most women tend to over-predict the risk. At this point, it does behoove not only that we have appropriate numbers of breast MRI centers but that the centers that exist are very high quality and eventually come under an accreditation process through the American College of Radiology.
BLOCK: And MRI tests are quite expensive and that raises a lot of questions about cost and insurance. Would these tests be covered?
Dr. RUSSELL: Currently, most private insurers will cover breast MRI in the screening vein for women who are known carriers of BRCA 1 and BRCA 2. What they're not covering for the most part are just random MRIs, out of curiosity, for women who feel they might be at high risk.
BLOCK: And What about for women on Medicare or Medicaid?
Dr. RUSSELL: Well, we would hope that these screening guidelines from the American Cancer Society will have a significant influence on the government insurance providers to change their recommendations so that it is covered. And that commonly happens when the American Cancer Society makes a screening guideline recommendation.
BLOCK: Now you're saying that these women should also still get a mammogram. Why is that?
Dr. RUSSELL: Because the MRI doesn't pick up every breast cancer. And so it's the complement of the two that actually would give the highest pickup rate of early breast cancers.
BLOCK: One problem with MRIs is that they do have quite a high rate of false positives. So where does that lead you?
Dr. RUSSELL: Well, that is the - why the recommendation's for women who are really at very high risk of developing breast cancer. Women who know that they're at risk are willing to accept a higher rate of biopsies that turn out to be benign. If you have a series of biopsies based on abnormal MRI, but your risk is not that high, the quality of a life in terms of fear and the significant costs really outweighs any benefit of doing.
BLOCK: And the bottom line is not all women should be running out to get an MRI test by any means.
Dr. RUSSELL: Absolutely. And I'm going to tell you, I'm not going to go get a breast MRI for myself because I do not sit in this high-risk group.
BLOCK: Doctor Christy Russell is chair of the Breast Cancer Advisory Group with the American Cancer Society. Doctor Russell, thanks very much.
Dr. RUSSELL: Thank you.
BLOCK: And if you want to see the complete guidelines, they're at our Web site, npr.org.