The Iowa Clinic is the first in the Des Moines area to offer abbreviated breast MRIs for detecting breast cancer.
by The Iowa Clinic on Tuesday, July 23, 2019
Mammograms are a life-saving tool in the fight against breast cancer. Screening mammograms have cut the death rate from breast cancer by nearly 40 percent.
For some women, the gold standard in breast cancer detection isn't enough. They require supplemental screening to provide radiologists with more information about their breast tissue. An abbreviated breast MRI is an innovation to an existing technology that gives doctors another breast cancer detection tool.
What is an abbreviated breast MRI?
It's a breast MRI, but shorter. Traditional breast MRIs can take up to 45 minutes to complete. The new abbreviated scans cut your time on the exam table down to 10 to 15 minutes.
"As we get the latest and greatest scan technology, we're able to move faster. But we're also taking only the most important sequences,"says Joshua Rosebrook, MD, radiologist at The Iowa Clinic.
Improvements in the technology and process cut down the time you're in the MRI machine without cutting the effectiveness of the exam. An AB-MRI gets the same results as a full breast MRI 97 percent of the time and detects breast cancers at a higher rate than other supplemental screening tools like breast ultrasounds, Dr. Rosebrook says.
Who is an abbreviated screening MRI for?
Women with dense breast tissue — which is 50 percent of women — are candidates for this screening.
Dense breast tissue presents problems for mammograms. Even 3D mammograms, which provide more accurate images of dense breast tissue, cannot always clearly show breast cancer.
"Increased density makes it harder to pick out breast cancer because of the masking effect," says Rachel Preisser, MD, a breast radiologist in The Iowa Clinic Women's Center. "Cancers show up white on a mammogram. So does dense breast tissue. They look the same. It's like looking for a snowman in a blizzard."
There are four categories of breast density: fatty breast tissue, scattered density, heterogeneous density and extreme density. Mammograms have trouble screening for cancers in women who fall into the upper two categories, heterogeneous and extreme density.
"An abbreviated breast MRI is for patients who are low to intermediate risk and whose breast density is in the upper two categories," says Dr. Rosebrook. "Those are the two categories of women for whom mammography is less effective and the chance for breast cancer is higher."
If you've gotten your annual screening mammogram within the past year, you should know whether your breast tissue is considered dense. The Iowa legislature passed a new breast density law that took effect in January of 2018, mandating that your mammogram report also contains information about your breast density and the potential need for supplemental screening. You should've received a letter from The Iowa Clinic Medical Imaging & Radiology Department, or wherever you got your mammogram, that details this information.
How accurate is an AB-MRI at detecting breast cancer?
"It's still considered a new and emerging technology. Clinical trials will be going on for another five years, but the preliminary results we have are promising and very compelling," Dr. Preisser says. "Abbreviated breast MRIs catch an additional 14 to 18 cancers per 1,000 patients screened for breast cancer."
In comparison, full breast ultrasound — another new supplemental breast cancer screening tool — only detects one additional cancer per thousand screenings. The goal of screening is to decrease the number of deaths from breast cancer, so every little step toward that goal means another life saved.
"We see 20,000 patients in our clinic for mammography every year. And about half of them are in the dense category," adds Dr. Rosebrook. "If we can help screen even 5 to 10 percent of those, it'd be great. It adds up pretty quick."
How much does an abbreviated breast MRI cost?
The technology is so new that the American College of Radiology has yet to write AB-MRI recommendations. Without medical guidance, insurance companies will not cover the cost of the procedure.
But the whole point of the abbreviated exam is to lower the cost and make supplemental breast cancer screening accessible to more patients. The length and complexity of a traditional MRI is a barrier. The cost has to cover the expense of the technology, the contrast dye used to light up your tissue and the time of the highly-trained medical professionals involved. By shortening the exam, the cost for a supplemental breast MRI drops from thousands of dollars to a few hundred.
The Iowa Clinic has improved efficiencies enough to reduce the length of the MRI to under 15 minutes and the time for a radiologist to interpret the results to five minutes or less. These innovations make abbreviated breast MRIs much more affordable at just $499.
"Cost has been one of the main hurdles in having MRI as a supplemental screening tool," says Dr. Preisser. "Shaving off time on the table and interpretation time really improves access. For patients who are worried about their breast density and have the resources, this is an option for them."
How do I get an AB-MRI?
Talk to your primary care provider about your breast density and your breast cancer screening options. They'll help you decide if the exam should be incorporated into your breast care as a supplement to your annual screening mammogram.
"This is in addition to, not in lieu of, a mammogram. There are still some breast cancers that can only be seen by mammography. That's the only test we have that randomized controlled trials have reduced morbidity and mortality in breast cancers," Dr. Preisser says.
"Abbreviated breast MRIs are certainly not in the recommended category," adds Dr. Rosebrook. "Nobody has to do this. It's an option for patients. It is going to be, from what the current research is saying, a more sensitive and specific test."