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<< Previous   of   Next >>   ADVERTISEMENT   CONTACT THE HERALD Melanie Munk, Features Editor munk@heraldnet.com   Published: Tuesday, November 27, 2007 Mammogram may not be enough for high risk group By Dr. Elizabeth Smoots Herald Columnist Getting a yearly mammogram may not be enough. The American Cancer Society says some women may need additional breast screening to look for cancer. The society released updated guidelines earlier this year that reflect a new understanding about screening. The big change is the addition of magnetic resonance imaging for women at high risk for breast cancer. Do you know what an MRI is, who needs it, and when to begin? Now is a good time for us to talk. Who needs an MRI? Starting at age 30, sometimes earlier, women at a high risk for breast cancer should get an MRI in addition to mammography, the cancer society says. "The two tests together give doctors a better chance of finding breast cancer early in these women, when it is easier to treat and the chance of survival is greatest," notes the society. The new advice may affect as many as 1.4 million women in the United States. Mammograms and MRI ar recommended for: Women with a genetic mutation involving the BRCA 1 or 2 genes. Women with a close relative (parent, sibling, child) who has a BRCA mutation. Women or close relatives of women with certain other rare inherited syndromes. Women exposed to chest radiation between the ages of 10 and 30 years Women with a 20 percent to 25 percent or greater lifetime risk for breast cancer, based on risk-assessment tools that depend largely on family history. A health care professional should conduct the evaluation. Which women might benefit from a risk-assessment evaluation? The American Cancer Society says a woman who has a family history with the following traits may need an assessment: Two or more close relatives (parent, sister, child, aunt, grandmother or half-sister) with breast or ovarian cancer, breast cancer occurring before age 50 years in a close relative, or both breast and ovarian cancer in the family. Other reasons for further investigation include one or more relatives with two cancers, which may involve breast and ovaries or a male relative with breast cancer. See your doctor for an assessment if you have any of these risk factors. MRI vs. mammogram Unlike the X-rays used to take mammograms, MRIs rely on magnetic fields to produce detailed breast images. During the procedure, a technician injects a chemical contrast agent, called gadolinium, to make certain cancers stand out more clearly on MRI. The cost for an MRI is much higher than that for a standard mammogram; the two complementary tests can be done at the same time or staggered every six months for women who need them. Another issue: The greater sensitivity of MRI scans leads to a greater number of false positive tests. These women may then need to undergo further testing and breast biopsy, which can create anxiety and potential adverse health effects. For these reasons, the American Cancer Society does not recommend MRI screening for women at average risk for breast cancer. Get routine screening Even if you're not at high risk, you still need regular screening for breast cancer. The deadly disease strikes about 178,000 women each year, killing 40,000. For early detection, the cancer society recommends a yearly mammogram starting at age 40. In addition, have your doctor do a clinical breast exam at least every three years during your 20s and 30s, and every year when you're age 40 or older. "Women should know how their breasts normally feel and report any breast change promptly to their health care providers," the cancer society says. For more information: American Cancer Society, www.cancer.org. Contact Dr. Elizabeth Smoots, a board-certified family physician and fellow of the American Academy of Family Physicians, at doctor@practicalprevention.com. Her columns are not intended as a substitute for medical advice or treatment. Before adhering to any recommendations in this column consult your health care provider. © 2007 Elizabeth S. Smoots

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