Abbreviated Breast MRI
Mammography screening is still the gold standard of breast cancer screening and the is only test shown to reduce deaths due to breast cancer. But mammography can miss some breast cancers, particularly in women with mammographically dense breast tissue (heterogeneously or extremely dense). Having the option for a Breast MRI or an Abbreviated Breast MRI (AB-MRI) is especially beneficial for these patients.
Iowa, along with more than 20 other states, now requires notification of breast tissue density to be communicated to patients.
What is Abbreviated Breast MRI (AB-MRI)
AB-MRI is a shorter version of a Breast MRI exam that has been around for the last 20 years. Instead of taking 30-45 minutes, AB-MRI includes only the most important sequences for detecting breast cancer and can be performed in 10-15 minutes. This allows patients to have a less costly but still incredibly sensitive exam that can detect breast cancer more accurately than mammography in patients with dense breast.
Schedule your exam by calling The Iowa Clinic Medical Imaging department at 515.244.5109.
What is breast density?
Breast tissue is composed of fat, milk glands and ducts, and connective tissues. The more connective and glandular tissue you have, the denser your breasts appear on your mammogram. The denser your tissue is, the harder it is for your Radiologist to see some types of developing breast cancers. Breast density does not always correlate with age or how your breasts feel. Having dense breast tissue is a common and normal finding. About 50% of women have dense breasts.
- Why is breast density important?
Dense breast tissue is important because the more dense, the more difficult it is to find some types of breast cancer on screening mammograms. Dense tissue can actually hide some cancers in their early stages when they have the best chance for a cure. In addition, recent research shows that patients with dense breast may also have an increased risk of developing breast cancer.
- How do I find out if I have dense breasts?
Breast density is determined when your radiologist reads your mammogram. This information has always been included in your mammography report that is sent to your healthcare provider. However, in 2018, in accordance with a new Iowa law, The Iowa Clinic began notifying patients directly in their mammogram results letter if they have dense breasts.
- If I have dense breasts, what other tests should I consider?
Studies have shown that ultrasound and MRI can find cancers that cannot be seen on a mammogram. Breast MRI, which also includes the AB-MRI, is by far the most accurate breast imaging test in use today. It is rare for a Breast MRI to miss an invasive breast cancer. To put this into perspective:
- Mammography detects, on average, 4-8 cancers per 1,000 women screened, less in those with dense breasts.
- Ultrasound can detect an additional 3-4 cancers per 1,000 women screened but is less accurate and requires more biopsies to find these cancers.
- Breast MRI can detect an additional 15-18 cancers per 1,000 women screened and has been shown to be greater than 90% sensitive and greater than 70-80% specific.
- What should I do if I have dense breasts?
If you have dense breasts, please speak to your healthcare provider. Together, you can decide if additional screening is right for you. In many cases, the deciding factor is related to your risk level. We recommend patients and their physicians consider AB-MRI as an excellent supplemental screening option.
- If AB-MRI is so accurate, why has it not been used more often?
Breast MRI has been recommended for many years for screening women who are at high risk for developing breast cancer. It has been limited to these women primarily because of its high cost. Now, with the new lower cost, the AB-MRI exam has been developed specifically for screening women with dense breasts. AB-MRI does not have radiation. It does not require breast compression and has a similar cancer detection rates as the standard, more expensive, Breast MRI exam.
- If I get AB-MRI, do I still need to have a mammogram?
Based on current American College of Radiology recommendations, women of average risk should continue with mammograms every year starting at age 40. Regardless of breast density, mammography is still the best test at detecting certain types of calcifications that can indicate breast cancer. Calcifications cannot be detected with Breast MRI or AB-MRI. Also, past mammograms remain important in determining the normal breast tissue pattern in each patient, because every pattern is different. Detecting changes in the mammographic pattern of your breast density remains critical in early cancer detection. In addition, mammograms are essential in interpreting your AB-MRI exam. It is recommended you have a recent mammogram (in the last 6 months) so it can be compared to your AB-MRI. If necessary, these exams can be scheduled on the same day.
- What if I have had a mammogram at a different facility?
If you have had a mammogram at a facility other than The Iowa Clinic, please let your scheduler know so we can request your prior images before you arrive. If it has been more than a year since your last mammogram, our schedulers can assist in scheduling your mammogram at The Iowa Clinic on the same day as your AB-MRI.
- Will I need additional tests after my AB-MRI?
There is not one breast cancer screening test that is perfect. On average, 20-30% of AB-MRI patients may need additional tests such as a follow up Breast MRI in 6 months, an ultrasound, or a diagnostic mammogram. In some cases, a finding may be suspicious enough to warrant a biopsy. Any additional imaging or biopsies based on your MRI results are typically covered by insurance and will be arranged by your referring physician and our Medical Imaging staff.
- How often should I get an AB-MRI?
Official guidelines for breast MRI screening in women of average to intermediate risk have not been established. However, based on current data from medical literature, along with the American College of Radiology and American Cancer Society guidelines, AB-MRI should be considered at 2-3 year intervals along with annual screening mammograms.
- Will my menstrual cycle have an effect on image quality?
For premenopausal women, the hormonal changes that occur during your menstrual cycle can have a major effect on the accuracy of AB-MRI (it can result in more false positives and potentially make it more difficult to detect a cancer). Assuming a normal 28 day cycle with day 1 being the first day of your menstrual period, the best time to have a AB-MRI is between day 7 and 14. If you have irregular cycles or you are less than age 55 and have had a hysterectomy but still have your ovaries, our radiologists will do their best to accurately interpret your examination.
- What if I am pregnant or nursing?
We do not perform AB-MRI on women who are pregnant or who are breast feeding but can schedule these tests for anytime 2 months after cessation of breast feeding.
- Does your MRI scanner have a size/weight limit?
Yes. The table weight limit is 350lbs and the size of the opening is 70cms. If size is a concern, please discuss this with our schedulers or you physician prior to scheduling.
- What if I have an implanted medical device or other contraindication to MRI?
Some medical devices and implants are MRI compatible, others are not. Please obtain and share your specific device model information with our staff when you call to schedule your exam. Our staff may need to check the safety of specific devices with our MRI technologists prior to scheduling. Items that are commonly not compatible with MRI or may need to be medically cleared are listed below:
- Cardiac Pacemaker
- Artificial heart valve prostheses
- Aneurysm clips
- Eye implants or metal ear implants
- Copper 7 IUD
- Shrapnel or non-removed bullet
- Any metal puncture(s) or fragment(s) in eye
- I have silicone gel or saline breast implants. Can I have an AB-MRI exam?
Yes. Breast implants are MRI safe and AB-MRI is an excellent way to see all of your breast tissue, which can sometimes be partially obscured by your implants on your mammogram. This is also a great way to ensure your implants remain intact after surgery.
- What if I am claustrophobic and fearful of small spaces?
Our MRI scanners have the widest opening in the industry measuring 70cm. Still, some patients become uncomfortable or fearful in small, enclosed areas (claustrophobic) or experience discomfort when lying on their chest for 10-15 minutes. If you dislike small spaces or have difficulty lying down on your stomach, please ask your referring healthcare provider to prescribe a sedative or pain medication to help you through the exam.
- I plan to take a sedative or pain medication. Do I need a driver?
Yes. If you plan to take sedative or pain medication before your exam, it is our policy that you come with someone who can drive you home.
- Can I eat and drink before my AB-MRI exam?
Intravenous contrast is required for the exam and we ask patients to have nothing to eat or drink 4 hours prior to your scheduled time.
- When should I arrive?
When you schedule your exam, you will be given an arrival time of 30 minutes before your actual MRI exam time. This will provide you enough time to check-in, complete necessary safety paperwork, review the details of the exam, change into a gown, receive your IV, and be ready for your MRI.
- What should I wear?
Comfortable clothes are encouraged for your exam. Do not wear anything metallic and leave bulky or metallic necklaces and other chest jewelry or piercings at home. You will be asked to change into a gown and remove your bra in our changing area. Here is where leave your purse, cell phone, clothes, and other valuables in a secure locker.
- What if I have additional questions prior to the exam?
You will fill out a questionnaire during an interview process with one of the MRI technologists. They will be able to answer any additional questions or concerns you may have.
- Will I need to have any injections?
A small amount of MRI dye or contrast agent (Gadavist) is injected during the exam to enable the visualization of any possible cancer. The technologist will place a small intravenous (IV) catheter in your arm for the injection. It is not possible to perform the exam without this contrast agent.
- What can I expect during the procedure?
After being escorted to the MRI room, you will be asked to lie face down with your breasts placed in a special imaging device called a coil that detects radiofrequency signals from the MRI machine. The breast coil is padded for your comfort and there is no breast compression. Your arms will be at your side or above your head. Once you are comfortable, the scanning table will slide you into the center of the MRI machine. The MRI maintains a magnetic field around you, and radio waves are directed from your body. You will not feel the magnetic field or radio waves, but you may hear loud tapping, thumping and other sounds coming from inside the machine. Headphones are provided with your choice of music to help dampen the noise and allow the technologist to communicate with you. Warm blankets are also available for your comfort.
- How long does the exam take?
Generally it takes 10-15 minutes. This does not include paperwork, changing, IV, positioning, etc. Sets of images will be obtained for 1-4 minutes at a time with short breaks in between. During the breaks it is important that you remain still.
- Do I need to lie still throughout the entire MRI exam?
Yes. AB-MRI is very sensitive to motion, which may not only cause inaccurate test results, but require the exam be repeated on another day. You will be instructed to breathe normally but to lie as still as possible until the exam is completed.
- Will a technologist be nearby?
Our MRI technologists are always able to see and communicate with you during the exam, but we attempt to keep talking to a minimum to reduce the chance of movement, which can blur the images.
- Does my insurance cover this procedure?
No. Because this exam is so new, it is not currently covered by insurance, including Medicare. You will be responsible to pay the $499, either in full or by an installment plan at check-in before your exam can be begin. This cost covers the MRI scan time and equipment, the MRI technologist, all paperwork, IV placement, IV contrast, the radiologist interpretation, image storage, and communication of results to your referring physician and you. Please call ahead of your scheduled appointment if you have any questions regarding payment options.
- Will Breast MRI eventually be a covered benefit through insurance?
The Iowa Clinic, The American College of Radiology, and other advocacy groups are working to get legislation passed through Congress which would encourage insurance companies to cover this exam. Additional research is also being done on the benefits and use of AB-MRI.
- What can I expect after the exam?
There is typically no downtime. The IV will be removed from your arm, you will be sent back to the changing area, and then you are free to leave.
- Are there any restrictions after the exam?
Unless you took relaxation medication, in which case a driver must be present, there are no restrictions after the exam. You may eat and drive.
- When can I expect to receive results?
Your AB-MRI exam will be interpreted by one of our radiologists specializing in breast imaging. A report will mailed to you in 3-5 business days. It will also be available through your referring physician or The Iowa Clinic patient portal within 1-2 business day of your exam.
- How do I find out the results of my exam?
If you have referred yourself for an AB-MRI, a results letter will be sent directly to you. We would also prefer to send a copy of the report to your primary care provider. Please include the name of your provider on the paperwork you are given at the time of check-in. If additional imaging and/or a needle biopsy is required to further evaluate an abnormality on your MRI, you will be contacted by telephone by The Iowa Clinic Medical Imaging staff.