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Is your breast cancer going undiagnosed?

Breast Cancer strikes one in nine women in America and is a leading cause for morbidity and mortality. The gold standard for detecting breast cancer has been mammography and breast physical exam. The combination is very effective in detecting breast masses in most patients.

However, in some women breast physical exam and mammography miss cancers. The lack of sensitivity of these traditional methods of detection is often due to the dense or nodular breast tissue. The dense breast obscure early cancers on mammography and nodular breast make it difficult to find a small cancer amid other benign lumps in the breast.

Most breast cancers occur in women without a family history of breast cancer or in women without a genetic predisposition for cancer to occur. However, some women have known genetic makers which make them likely to develop breast cancer. These patients’ cancers occur at a younger age and their cancers tend to be more aggressive.

Aggressive cancers are faster growing and more malignant than normal making them harder to cure. These cancers need to be detected earlier to allow a better chance for cure. Mammography and breast physical exam may not detect cancer soon enough in these women to prevent them from presenting at a late stage.

There is a modality and an exam available for years which has recently has gained much attention due to its great sensitivity for detecting early breast cancer. MRI of the breast is the most sensitive for detecting cancer before any other modality. The test can identify malignancies in even the densest breasts and can localize early cancers in patients with a strong family history or a genetic predisposition. The test is now considered essential in these patients or in any patient considered high risk.

The downside of using MRI to detect breast cancer is that it can be too sensitive. The exam detects most things mammography does (with the exception of micro-calcifications) and much more. MRI finds so many suspicious lesions that many more biopsies have to be performed to exclude cancer. There are many benign lesions which would not have been seen or biopsied without MRI. These ‘unnecessary’ biopsies are acceptable to most women who have an elevated risk of developing cancer.

The drawback is mainly financial. The costs for screening the millions of women each year that would need a breast MRI are great. The exam costs about one to two thousand dollars depending on where you live and what type of insurance you carry. It is about ten to twenty times the cost of a screening mammogram. Also, the biopsies which are performed because of the MRI findings have high costs associated with them too. They can range from a few hundred dollars for a simple biopsy to thousands of dollars for an open, surgical biopsy. Remember, these masses that are biopsied are often benign. The cost benefit ratio or the efficacy for breast MRI has determined and the test is warranted in any woman with risk factors described above. The test can lead to early detection and cure. Without it we will be losing lives which shouldn’t be lost.

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