Why Young Women Need Breast MRIs before the age of 40...The Scientific Proof
Breast Cancer Screening: MRI Sensitive, No Added Value With Mammography, Study Suggests
ScienceDaily (Mar. 8, 2010) — Do we need a revision of current recommendations for breast cancer screening? According to a recent prospective multicenter cohort study published in the Journal of Clinical Oncology, this appears advisable at least for young women carrying an increased risk of breast cancer. The results of the EVA trial confirm once more that magnetic resonance imaging (MRI) is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound: MRI is three times more sensitive for breast cancer than digital mammography.
For the EVA trial, almost 700 women were enrolled. Aim of the trial was to refine existing guidelines for surveillance of women at high and moderately increased risk of breast cancer. Findings suggest that in these women, MRI is essential for early diagnosis -- and that a mammogram or an ultrasound examination does not increase the "cancer yield" compared to what is achieved by MRI alone. Researchers conclude that annual MRI is not only necessary, but in fact sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and should be discontinued. Moreover, MRI screening is important not only for women at high risk, but also for those at moderately increased risk.
Between 2002 and 2007, the EVA trial recruited 687 women who carried a moderately increased risk of breast cancer (lifetime risk of 20% and over). Women underwent 1679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound examinations. During this time span, 27 women received a new diagnosis of invasive cancer or DCIS (Ductal Carcinoma In Situ).
Of all imaging methods under investigation (digital mammography, ultrasound and MRI), MRI offered by far the highest sensitivity: MRI identified 93% of breast cancers. 37% of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33%). These results confirm once more that MRI is essential for surveillance not only of women at high risk, but also for women at moderately increased risk of breast cancer. Moreover, the results contradict current guidelines according to which mammography is considered indispensable for breast cancer screening. One aim of the EVA trial was to question this concept and to ask whether it is still appropriate to require that MRI should only be used in addition to mammography. The results speak for themselves: If an MRI is available, then the added value of mammography is literally negligible. Researchers conclude that MRI is necessary as well as sufficient for screening young women at elevated risk of breast cancer. Since mammography appears to be unnecessary in women undergoing MRI, its use is no longer justifiable, and current guidelines should be revised to reflect this.
Current guidelines questionable
Current guidelines for women at high familial risk of breast cancer recommend annual MRI (with or without ultrasound) and annual MRI starting at age 25-30. "These guidelines were set up based on little or no scientific evidence, and mainly reflect expert opinion," summarizes Prof. Christiane Kuhl, radiologist at the University of Bonn and principal investigator of the EVA trial. "In the light of the results of the EVA trial, such recommendations should be revisited." This seems even more important because digital mammography uses x-rays (ionizing radiation) to detect breast cancer. "The radiation dose associated with regular mammographic screening is clearly acceptable and safe," underscores Kuhl. "However, regular mammographic screening usually starts at age 40-50." The situation is different if systematic annual mammographic screening is started at age 25-30. "Not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation." This appears to be especially true for BRCA mutation carriers. "Accordingly, we impose more radiation on less radiation-tolerant breast tissue -- for a very limited, if any, diagnostic benefit." Therefore, Kuhl advocates a revision of existing guidelines: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI."
MRI is a mature technology
In the past, MRI was used strictly in addition to mammography only. The allegedly high rate of "false positive" diagnoses and the allegedly insufficient sensitivity for DCIS were the main reason to discourage its use as a stand-alone method for breast cancer screening. "In this multicenter trial, with basic quality assurance implemented not only for mammography, but also for MRI, we were able to prove that false positive diagnoses are avoidable if MRI studies are interpreted with adequate radiologist expertise." In the EVA cohort, the Positive Predictive Value achieved with MRI was already even higher than that of mammography or breast ultrasound. "Moreover, we found that MRI offered the highest sensitivity especially for DCIS," adds Dr. Kuhl. "It is simply wrong to state that we need a mammogram to detect intraductal cancer."
Kuhl et al. Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial. Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.23.0839
Breast Cancer Screening: MRI Sensitive, No Added Value With Mammography, Study Suggests
ScienceDaily (Mar. 8, 2010) — Do we need a revision of current recommendations for breast cancer screening? According to a recent prospective multicenter cohort study published in the Journal of Clinical Oncology, this appears advisable at least for young women carrying an increased risk of breast cancer. The results of the EVA trial confirm once more that magnetic resonance imaging (MRI) is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound: MRI is three times more sensitive for breast cancer than digital mammography.
For the EVA trial, almost 700 women were enrolled. Aim of the trial was to refine existing guidelines for surveillance of women at high and moderately increased risk of breast cancer. Findings suggest that in these women, MRI is essential for early diagnosis -- and that a mammogram or an ultrasound examination does not increase the "cancer yield" compared to what is achieved by MRI alone. Researchers conclude that annual MRI is not only necessary, but in fact sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and should be discontinued. Moreover, MRI screening is important not only for women at high risk, but also for those at moderately increased risk.
Between 2002 and 2007, the EVA trial recruited 687 women who carried a moderately increased risk of breast cancer (lifetime risk of 20% and over). Women underwent 1679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound examinations. During this time span, 27 women received a new diagnosis of invasive cancer or DCIS (Ductal Carcinoma In Situ).
Of all imaging methods under investigation (digital mammography, ultrasound and MRI), MRI offered by far the highest sensitivity: MRI identified 93% of breast cancers. 37% of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33%). These results confirm once more that MRI is essential for surveillance not only of women at high risk, but also for women at moderately increased risk of breast cancer. Moreover, the results contradict current guidelines according to which mammography is considered indispensable for breast cancer screening. One aim of the EVA trial was to question this concept and to ask whether it is still appropriate to require that MRI should only be used in addition to mammography. The results speak for themselves: If an MRI is available, then the added value of mammography is literally negligible. Researchers conclude that MRI is necessary as well as sufficient for screening young women at elevated risk of breast cancer. Since mammography appears to be unnecessary in women undergoing MRI, its use is no longer justifiable, and current guidelines should be revised to reflect this.
Current guidelines questionable
Current guidelines for women at high familial risk of breast cancer recommend annual MRI (with or without ultrasound) and annual MRI starting at age 25-30. "These guidelines were set up based on little or no scientific evidence, and mainly reflect expert opinion," summarizes Prof. Christiane Kuhl, radiologist at the University of Bonn and principal investigator of the EVA trial. "In the light of the results of the EVA trial, such recommendations should be revisited." This seems even more important because digital mammography uses x-rays (ionizing radiation) to detect breast cancer. "The radiation dose associated with regular mammographic screening is clearly acceptable and safe," underscores Kuhl. "However, regular mammographic screening usually starts at age 40-50." The situation is different if systematic annual mammographic screening is started at age 25-30. "Not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation." This appears to be especially true for BRCA mutation carriers. "Accordingly, we impose more radiation on less radiation-tolerant breast tissue -- for a very limited, if any, diagnostic benefit." Therefore, Kuhl advocates a revision of existing guidelines: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI."
MRI is a mature technology
In the past, MRI was used strictly in addition to mammography only. The allegedly high rate of "false positive" diagnoses and the allegedly insufficient sensitivity for DCIS were the main reason to discourage its use as a stand-alone method for breast cancer screening. "In this multicenter trial, with basic quality assurance implemented not only for mammography, but also for MRI, we were able to prove that false positive diagnoses are avoidable if MRI studies are interpreted with adequate radiologist expertise." In the EVA cohort, the Positive Predictive Value achieved with MRI was already even higher than that of mammography or breast ultrasound. "Moreover, we found that MRI offered the highest sensitivity especially for DCIS," adds Dr. Kuhl. "It is simply wrong to state that we need a mammogram to detect intraductal cancer."
Kuhl et al. Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial. Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.23.0839
Why The Before Forty Initiative Is Needed NOW more than EVER
A government task force has declared that women no longer require mammograms at the age of 40. Rather, women should wait until 50 and then follow-up should be every two years instead of annually. Further, they have announced that women no longer perform breast self exams. At all.
Their reasoning is:
To save money
To prevent unnecessary anxiety
Too many false positives are found
If one woman out of a thousand falls through the cracks and has her cancer missed and she dies, it is worth it because the other 999 women won’t have anxiety about getting a mammogram.
THE NO SURRENDER BREAST CANCER FOUNDATION CATEGORICALLY OPPOSES THESE RECOMMENDATIONS.
Our Reasons?
We are women with breast cancer. Most of us had our cancer found by mammography or breast self exam. Most of us were either in our forties and many of us were under forty.
The women who had late mammograms, often had an advanced cancer detected
Young women, particularly African American and Hispanic women, will die if they follow these guidelines because this group normally gets breast cancer young, before forty, and the type they get is highly aggressive and is only controllable if it is found at it’s earliest stage, before forty.
The anxiety of a mammogram is nothing compared to the anxiety a woman feels when she learns that not only does she have breast cancer, but she has advanced disease and there is no treatment. If her tumor was found earlier, she would have had a fighting chance.
We have been working on this for months
As those of you who are familiar with Before Forty, you know, that the most deadly of cancers, Triple Negative disease, is found in African American and Hispanic women under the age of 40. Without early screening, BEFORE FORTY, the chance of fighting the disease is much harder if the tumor is not found at its earliest stages. Also, as the women of the No Surrender Women know, you don’t know if you carry genes that cause breast cancer unless you are diagnosed with it in the first place.
The article clearly states that this measure is to reduce costs. The article blatantly disregards the thousands of lives of women who die because they were diagnosed too late, after their cancer has spread to other organs.
This is the Premeditated Murder of thousands of women.
THIS IS WHY BEFORE FORTY NEEDS YOU NOW MORE THAN EVER. Lift up your voices and fight for the women who are coming after us. Do not become an accessory to this murder.
What is Before Forty?
The Before Forty Initiative
Women are told that they should get their first mammogram at the age of forty. For the woman whose cancer is present before the age of forty, this recommendation could have deadly consequences. Young women have more aggressive cancers that grow at a rapid rate and can spread beyond the breast before they are detected. This is particularly true for African American and Hispanic women who have a higher rate of developing a type of breast cancer known as “triple negative.”
Triple Negative breast cancer does not respond the hormones estrogen and progesterone, and is not fueled by the HER2/nue protein. It also is a more rapidly growing disease. There are certain subtypes of TNBC that are “basal,” or “luminal A,” which are so deadly, they have the same survival rate as pancreatic cancer. These subtypes are most often found in the African American and Hispanic community and in women who carry the gene variant BRCA1 and BRCA2. Women of Ashkenazi heritage are carriers of this gene variant.
These cancers are very difficult to control. The only defense a woman has is by finding it before it grows and spreads. A woman does not have that chance if she waits until the age of forty to get her first mammogram. It will be too late. What could have been a rescue mission turns into a recovery mission, offering only palliative care.
This does not have to be. The founder of the No Surrender Breast Cancer Foundation was given baseline mammograms starting at the age of 35. At age 39, a triple negative tumor was found in a follow-up mammogram. An abnormality had been detected because there was a change from her earlier mammograms. Had this been her first mammogram, it would have been considered normal tissue. Because her tumor was found early, she was able to have it removed, do a six month course of chemotherapy followed by radiation, and has been free of triple negative disease for eight years.
Since the inception of the website, many women, members of the NSBCF Support Forum, have died because their tumors were found too late. One woman was Ferne Dixon. She was a young, vibrant African American woman who never had a baseline mammogram. She was told she was too young to worry about the lump she had found. When the lump was larger, she finally went for a mammogram and her triple negative cancer was found. It was too late. Even though she endured months of chemotherapy and radiation, her disease spread and took her life. She said that if she had not had the lump she would not have gone for the mammogram, even though she knew that it was recommended. She was 41 when she was diagnosed. She discovered that many African American women have a false sense of security because most breast cancer is found in Caucasian women. This statistic is true, however, most of the deadly, triple negative breast cancers are found in young, African American women and women who carry the BRCA1 gene variant.
The No Surrender Breast Cancer Foundation's Before Forty Initiative is dedicated to promoting the importance of early, baseline screening for all young women, before the age of forty. If a woman is African American, Hispanic or in a high risk group, we will become the leading advocate for comprehensive screening before the age of 35.
Simple mammography is not enough. Young women have dense breasts and many doctors tell them it is too difficult to accurately read a mammogram. Young women need more than mammograms. They need breast MRIs. This is particularly true if there is an abnormality detected. The NSBCF seeks to change the standard of care so that breast MRIs are not only offered, but covered by insurance.
The second phase of this standard of care is to put an end to the “Watch and Wait” practice of medicine. Most young women are told, when an abnormality is found, that they have dense breasts and they should “watch and wait” and reevaluate the lump in six months. During this time, a triple negative tumor can triple in size and spread to the lymph nodes and distant organs. Watching and waiting for cancer to become deadly must stop. Making women aware of the danger of this practice will save lives. The NSBCF is making this a major part of the Before Forty Initiative.
The Before Forty Initiative:
• Increase awareness to young women about the risk of breast cancer. Inform them of the better prognosis and treatment options if their cancer is found early.
• Make the age of 35 be the standard for baseline screening. Make the age of 30 the standard for high risk groups. The screening should be by breast MRI.
• Get insurance companies to cover baseline MRI and subsequent follow-up diagnostic tests if warranted.
• Increase awareness for African American and Hispanic women about Triple Negative Breast Cancer. Educate young women that African American and Hispanic women are at a higher risk of TNBC and have a poorer prognosis. The only way they can beat the disease, should they get it, is if it is found early.
• Never “Watch and Wait.” Teach women the deadly consequences of waiting for a cancer to grow in six months.
We have lost too many young women before the age of forty to let this continue any further. We seek to save lives. We will not stop until the standard of care is Before Forty.
We need YOU.
We need your voices.
We need your help spreading the word.
We will NOT accept these guidelines and we will fight against them until they are gone.
Ferne Dixon and Gina Maisano
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