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New approach makes breast MR more affordable for women with extremely dense breasts

John R. Fischer, Senior Reporter | October 22, 2021
MRI Women's Health
Performing breast MR every three or four years may produce optimal diagnoses and be more cost-effective
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.

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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.

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