Earlier this year, the American Cancer Society released new breast cancer screening guidelines recommending that high-risk women receive an annual MRI along with their mammogram.
Yet many argue that there has been no conclusive study to show that lives can be saved by possible earlier detection of breast cancer through MRI.
If anything, many of the tumors found by MRI - or, for that matter, by mammography -- are probably harmless, say Dr.Susal Love and Sue Rochman, writing in the Ms.Magazine.
In August last it was reported in The Lancet itself that MRI scans were better at detecting breast cancer at its earliest stage, but a Canadian expert pointed to the fact that MRI was expensie and for various reasons MRI would never come to be used routinely as a breast cancer screening tool.
A study by Dr. Christiane Kuhl, a radiologist at the University of Bonn, found that magnetic resonance imaging was better than standard mammograms at detecting a non-malignant tumour called "ductal carcinoma in-situ," or DCIS.
Almost all malignant breast cancer is believed to start out as DCIS, which are non-invasive cancerous cells in the milk ducts.
Kuhl's team wanted MRI to become a standard screening tool.
MRIs are used routinely for patients considered at high risk of breast cancer, such as those with a family history and key genetic markers.
Reacting to Kuhl's findings, Dr. Ellen Warner, a Toronto-based medical oncologist said MRIswere not only expensive, but they also picked up "lots and lots" of false positives. (A result that is erroneously positive when a situation is normal is called false positive.)
Thus those patients wrongly identified often had to undergo unnecessary and painful biopsies and follow-up, sometimes all for nothing.
She told the CTV.ca that detecting more cases of DCIS did not necessarily mean that doctors would be able to prevent more breast cancer deaths.
"A 10-mm DCIS may not become invasive and lead to cancer, whereas a 1-mm might," she says. "There are a lot of other factors at play."
Anyway, it is noted that having an MRI does not save women from undergoing the uncomfortable mammogram process, as MRIs are always done alongside mammograms.
There are other diagnostic technologies becoming available, such as digital mammography, which improves breast imaging and becoming more widely adopted across Canada.
Another tool that is still at the experimental stage is called breast tomosynthesis, which takes a series of images that are mathematically processed into a series of one millimeter slices that show the tissue structure in three dimensions.
Why aren't we trying to find ways to prevent these cancers from even occurring so that women won't ever need to have surgery? It's because it's easier and more lucrative for the research-industrial-medical complex to improve on what we have (me-too drugs, for example) than to explore completely different approaches to the problem, Dr.Love and Rochman assert.
What if we could squeeze a drop of fluid from our breast ducts, where all breast cancer starts, and put it on a dipstick? If the stick turned blue, you would know that you had the conditions in your breast that might lead to cancer. What if breast cancer, like cervical cancer, is actually caused by a virus, and a vaccine could be developed to prevent it? What if we could treat breast cancer by putting chemotherapy into the breast ducts?
We need to foster more doctors and researchers who are willing to look at breast cancer with fresh eyes and without preconceived notions, and we need a mechanism to fund them to test their ideas.
Women should not be clamoring to be classified as high-risk patients in order to get MRIs; instead, they should be demanding high-risk research that has the potential to bring us closer to our goal: ending breast cancer. Now, the duo say.