Using MR to screen women for breast cancer may be more affordable than originally thought.

That’s what a group of Dutch researchers, of Erasmus University Medical Center in Rotterdam, are proposing in a new study. They say that overcoming this obstacle may help make MR imaging more accessible, especially for women with very dense breast tissue. Such patients have an increased risk of developing breast cancer and mammographic screening is often inaccurate in identifying breast cancer due to its low sensitivity and the density of their breast tissue obscuring tumors.

The study is titled, “Cost-effectiveness of MRI screening for women with extremely dense breast tissue.” For it, the researchers used data from a large breast cancer screening trial and other research on breast cancer outcomes to evaluate cost-effectiveness when adding MR to mammographic screening.

When used with mammography every two years, MR resulted in the highest costs but not the highest gains in quality-adjusted life years. Mammography alone yielded the lowest total costs and lowest impact on survival. When researchers alternated between the two modalities every two years, cost declined and only a few cancers were not picked up.

They also looked at other time intervals, they wrote in their study. “MR screening is cost-effective for women with extremely dense breasts, when applied at a four-year interval. For a willingness to pay more than €22 000 (over $25,000) per QALY gained, MR at a three-year interval is cost-effective as well."

Since February 2019, U.S. doctors have been required by federal law to notify women of their individual breast density and the diagnostic implications that come with it. About 10% of women have extremely dense breasts but are not recommended by current mammography screening guidelines to seek additional imaging unless they have a strong family history or genetic risk for breast cancer.

Due to its higher sensitivity, breast MR surpasses mammography in detecting signs of breast cancer but is more expensive and often not covered by insurers. Patients frequently are stuck paying for the exams themselves. Because of the fear, anxiety and distrust over inaccurate readings by mammography machines, many women choose to pay out-of-pocket for breast MR, regardless of its risks, which may include adverse contrast reactions, false positives and unnecessary biopsies, according to a study published in April.

But another study in 2019 said that breast MR may lead to unnecessary biopsies and found that while it found more breast cancers, breast MR combined with mammography showed no difference in distinguishing breast cancer from other findings (sensitivity) or ruling cancer out (specificity), compared to mammography alone. The combination also resulted in twice as many biopsies.

Breast MR also requires a lot of time to complete, though this has been partially remedied with the introduction of abbreviated breast MR. A group of South Korean researchers earlier this year found that using abbreviated breast MR reduced scanning time from 30 minutes to 10 minutes and was able to reduce costs, while still efficiently identifying signs of cancer.

U.S. and German researchers found in 2020 that abbreviated MR was better than digital breast tomosynthesis in detecting breast cancer. “Our study confirmed that AB-MR in women at average risk with dense breast tissue outperforms 3D mammography by a factor of 2.4 times in detecting women with breast cancer. And not only does it find more cancer, but it finds invasive and high-grade cancers not found on the 3D mammography,” Dr. Christopher Comstock, of MSK and the study’s lead author, told HCB News at the time.

The findings for the current study were published by Oxford University Press in the Journal of the National Cancer Institute.