Wednesday, March 28, 2007

MRIs suggested for breast imaging

The American Cancer Society (ACS)came out with a fairly bold recommendation yesterday for dramatically expanding the use of MRI for screening breast cancer patients. A summary of this by WebMD can be read here.

The proposed groups which fall under these new guidelines are:

1. They carry mutations in the BRCA1 or BRCA2 breast cancer genes.

2. They have a parent, sibling, or child with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves.

3. Their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk-assessment tools that look at family history and other factors.

4. They had radiation to the chest between the ages of 10 and 30.

5. They have a rare medical condition linked to breast cancer -- Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome -- or have a parent, sibling, or child with one of these syndromes.

When you calculate the groups who fall into the nominally "high risk" group, it's somewhere between 1.6 to 2 million women annually who would be suggested to have MRI's. Right now it costs somewhere between $800-2000 per study so this is well over a billion dollars of potential new imaging study costs for our health care system (which is not pocket change for even federal programs like Medicare).

This will be interesting on how this plays out. The growth in imaging studies (mostly CT/MRI)are already one of the budget busters when you consider health care on a systems basis. Do not expect health insurers to quickly accept this recommendation by the ACS until they are forced kicking & screaming with long-term outcome data. Counter intuitively, we learned (read here)not to long ago that aggressively screening patients presumed to be at risk for lung cancer had ZERO effect on cancer-specific mortality and caused a great deal of morbidity from the work up of masses that may never have caused a problem.

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