The American Cancer Society has just recommended that breast MRIs be performed in addition to mammograms in women who are estimated to have a lifetime risk of developing breast cancer of 25%, primarily those women with a signfiicant family history of breast cancer. The evidence on breast MRI indicates that this technique can more reliably detect smaller breast cancers than mammography, although it is also associated with far more “false positives”, a questionable finding that generates anxiety and gets worked up but turns out to be something other than cancer. The recommendation in favor of breast MRI for higher risk people is based on its ability to find tumors, not on improving survival.
For anyone following the issue of lung cancer screening with CT, this is the argument people make against lung cancer screening: that while it definitely can pick up tumors earlier, it also detects many false positives, and it’s not proven yet that detecting these smaller tumors improves survival from lung cancer. So you may ask yourself, “why will society now routinely cover breast MRI scans when the evidence is the same as it is for lung cancer screening with CT, which it doesn’t cover?”. I can only answer that the breast cancer lobby is apparently more effective than the lung cancer lobby, and that our society cares more about breast cancer than lung cancer, likely because of the “blame the victim” mentality of lung cancer. There are four times as many deaths from lung cancer as from breast cancer each year, but the resources are not placed toward lung cancer.
I try to be balanced in my discussion about the pros and cons of screening, but I cannot explain why the equation should be different for breast cancer vs. lung cancer, except that it reflects power and priorities in our society, so the same rules don’t seem to apply equally across the board. It is frustrating for me, as well as for all of the victims of this disease, to see a finite amount of resources allocated so unequally, and so consistently against the lung cancer community.
posted by Dr. West @ 9:41 am link to this post
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April 4th, 2007 at 8:26 pm
I need help, my sister-n-law age 40 with a two month hx of intermittent cough had a cxr on one day, biopsy of a supraclavicular node on the next day and CT on the third day and the fourth day she was on chemo. She has NSCLC, 9cm tumor in the mediastinum wiht innumerable tumors in both lungs. I am amazed at this disease, she is a NON SMOKER! I am a two time breast cancer survivor and went thru a heck of time and you are right, I have been inundated by Pink! I want to help her, I want to help those with Lung CA, it’s mind boggling when you get this type of dx. What are her options, they say surgery out and radiation is out for now. Chemo is the standard Avastin, Carbo and a third drug that escapes me. She has had one treatment, this just happened a week and a half ago.
April 3rd, 2007 at 10:11 pm
Welthy points out how controversial screening recommendations can be, and not just about lung cancer. Even experts, working with the same evidence, can produce different guidelines. I have no idea how this will shake out.
Barb, prior RT does tend to increase the risk for “secondary cancers” in the radiation field, but it tends to be decades after the radiation was given. I wouldn’t be able to make any recommendations about whether someone with prior RT should get an MRI. If someone is alive after treatment with lung cancer for long enough to even consider the risk of secondary cancers, they’ve have great success and beaten some hard odds with lung cancer. In general, though, when I consider that the risk from RT is usually 20-30 years after it was given, and most patients getting RT for lung cancer are 50 or older, I don’t think the increased risk for breast cancer is clearly raised enough to change from standard screening recommendations. However, this is more of a question for a breast cancer expert than a lung cancer expert.
-Dr. West
April 3rd, 2007 at 2:30 pm
Hi Dr West, I agree….the radiation from mammogram seems insignificant after chest RT.
But does previous chest RT put women in a higher risk category for breast cancer? And should those women be getting breast MRI’s to improve early detection of breast cancers?
Barb
April 3rd, 2007 at 2:18 pm
Oops, the last part of the first line in my post should have read “for women under 50″, NOT breast cancer patients. Sorry!
April 3rd, 2007 at 2:16 pm
In light of the above discussion, it will be interesting to see the fallout from the new recommended testing guidelines for breast cancer patients under 50.
WASHINGTON - The nation’s largest medical specialty group is challenging the widely accepted recommendation that women should routinely undergo mammograms in their 40s, saying the risks of the breast exams may outweigh the benefit for many women.
Reopening a long-running debate, the American College of Physicians, which represents 120,000 internists, plans to issue new guidelines Tuesday that instead urge women in their 40s to consult with their doctors individually about whether to get the breast X-rays.
The group based its recommendations on a comprehensive review of research on mammography that concluded the benefit is less clear for women in their 40s than for those 50 and older, and that screening carries significant risks, including exposure to radiation and unnecessary biopsies, surgery and chemotherapy.
The guidelines conflict with long-standing recommendations from several other leading medical groups, including the American Cancer Society and National Cancer Institute.
April 3rd, 2007 at 9:01 am
Barb,
I’d have to qualify my comments by saying that I’m not an expert on breast cancer surveillance. I think PET scans (which most of us aren’t doing routinely for surveillance yet) and/or chest CTs certainly can provide some assurance, but they aren’t the test of choice for breast imaging, especially for smaller lesions. So I think it would be better than nothing but not a straightforward replacement. In terms of the question on subseuqent radiation from mammograms, I would not be inclinde to recommend the most established test to detect small, occult breast lesions based on the cumulative effects of radiation. Many people in the lung cancer community feel that we can and perhaps should go beyond the current standard RT doses for lung lesions, and the newer, escalated doses that are being tested are far beyond what you’d get from doing yearly mammograms. So I don’t think these issues would factor in significantly to change my recommendations for breast cancer screening. Of course, if a patient of mine has advanced lung cancer, SCLC or NSCLC, I don’t see great value in doing screening for a breast cancer that would be exceptionally unlikely to have a clinical impact on the course of events.
-Dr. West