Freitag, 18. November 2011


New study reveals expensive MRIs pushed on women for breast cancer screening have no medical benefit

Friday, November 18, 2011 by: S. L. Baker, features writer

(NaturalNews) The use of Magnetic Resonance Imaging, better known simply as MRI, for breast cancer screening is increasing and so is its use in guiding breast surgery when cancer is discovered. Obviously, that means healthcare costs are soaring, too, as more and more women are advised to get MRIs in addition to mammograms. The push started in 2007. At that time, the New York Times reported a breast MRI cost $1,000 to $2,000, and sometimes more -- at least 10 times the cost of mammography. So for every million breast MRIs performed each year, healthcare costs spike by at least a billion dollars. Sometimes, but not always, these test are covered by Medicare and insurance.

Of course, despite this enormous cost, the only reason doctors and medical centers would be urging women to have these expensive tests is because there must be convincing proof breast MRIs are excellent for spotting breast cancer and/or for directing cancer therapy. But this is not true.

Although it may be hard to believe, here comes the shocking truth, as just reported in the prestigious medical journal The Lancet. Monica Morrow from Memorial Sloan-Kettering Cancer Center, New York, and colleagues meticulously reviewed research from the past decade to examine the belief that breast MRIs are effective at finding and treating breast cancer. What they found was just the opposite. There is little to no evidence breast MRIs benefit the vast majority of women. In fact, there's not even evidence showing breast MRIs are particularly effective at helping direct breast-conserving surgery.

Selling women on breast MRIs with no proof the tests increase survival

The new study did indicate breast MRI can be valuable in screening women at very high risk for breast cancer due to their genetic heritage. However, let's take a closer look at that finding. According to a media statement, the researchers noted that while a breast MRI can identify tumors missed by mammograms and ultrasound in women at risk of breast cancer due to a known gene mutation or their family history, "little is known about whether or not this improved detection has any impact on survival."

"MRI has, over recent years, been widely adopted into clinical practice based on the assumption that its increased sensitivity at detecting cancer will improve outcomes for patients," the authors noted in a media release. Bottom line: they found there's no actual evidence having a breast MRI that spots cancer in a high risk woman means they will live any longer than they would have if they'd never had the test.

According to the research team, that fact that breast MRIs produce more sensitive images does not translate into better surgical treatment or prognoses when used to evaluate women before surgery, either. "The available data does not support the idea that MRI improves patient selection for breast-conserving surgery or that it increases the likelihood of obtaining negative margins [no cancer cells found in margins of resection] at the initial surgical excision," they wrote.

Sources for this article include:

The Lancet Oncology

The Lancet Oncology, Early Online Publication, 15 November 2011
doi:10.1016/S1470-2045(11)70283-2Cite or Link Using DOI
Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial

Esther M Stoop MD a †, Margriet C de Haan MD b †, Thomas R de Wijkerslooth MD c, Prof Patrick M Bossuyt PhD d, Marjolein van Ballegooijen MD e, C Yung Nio MD b, Prof Marc J van de Vijver MD f, Katharina Biermann MD g, Maarten Thomeer MD h, Monique E van Leerdam MD a, Prof Paul Fockens MD c, Prof Jaap Stoker MD b, Prof Ernst J Kuipers MD a i, Dr Evelien Dekker MD c

Screening for colorectal cancer is widely recommended, but the preferred strategy remains unidentified. We aimed to compare participation and diagnostic yield between screening with colonoscopy and with non-cathartic CT colonography.

Members of the general population, aged 50—75 years, and living in the regions of Amsterdam or Rotterdam, identified via the registries of the regional municipal administration, were randomly allocated (2:1) to be invited for primary screening for colorectal cancer by colonoscopy or by CT colonography. Randomisation was done per household with a minimisation algorithm based on age, sex, and socioeconomic status. Invitations were sent between June 8, 2009, and Aug 16, 2010. Participants assigned to CT colonography who were found to have one or more large lesions (≥10 mm) were offered colonoscopy; those with 6—9 mm lesions were offered surveillance CT colonography. The primary outcome was the participation rate, defined as number of invitees undergoing the examination relative to the total number of invitees. Diagnostic yield was calculated as number of participants with advanced neoplasia relative to the total number of invitees. Invitees and screening centre employees were not masked to allocation. This trial is registered in the Dutch trial register, number NTR1829.

1276 (22%) of 5924 colonoscopy invitees participated, compared with 982 (34%) of 2920 CT colonography invitees (relative risk [RR] 1·56, 95% CI 1·46—1·68; p<0·0001). Of the participants in the colonoscopy group, 111 (9%) had advanced neoplasia of whom seven (<1%) had a carcinoma. Of CT colonography participants, 84 (9%) were offered colonoscopy, of whom 60 (6%) had advanced neoplasia of whom five (<1%) had a carcinoma; 82 (8%) were offered surveillance. The diagnostic yield for all advanced neoplasia was 8·7 per 100 participants for colonoscopy versus 6·1 per 100 for CT colonography (RR 1·46, 95% CI 1·06—2·03; p=0·02) and 1·9 per 100 invitees for colonoscopy and 2·1 per 100 invitees for CT colonography (RR 0·91, 0·66—2·03; p=0·56). The diagnostic yield for advanced neoplasia of 10 mm or more was 1·5 per 100 invitees for colonoscopy and 2·0 per 100 invitees for CT colonography, respectively (RR 0·74, 95% CI 0·53—1·03; p=0·07). Serious adverse events related to the screening procedure were post-polypectomy bleedings: two in the colonoscopy group and three in the CT colonography group.

Participation in colorectal cancer screening with CT colonography was significantly better than with colonoscopy, but colonoscopy identified significantly more advanced neoplasia per 100 participants than did CT colonography. The diagnostic yield for advanced neoplasia per 100 invitees was similar for both strategies, indicating that both techniques can be used for population-based screening for colorectal cancer. Other factors such as cost-effectiveness and perceived burden should be taken into account when deciding which technique is preferable.

Netherlands Organisation for Health Research and Development, Centre for Translational Molecular Medicine, and the Nuts Ohra Foundation.