THE HEALTH INFORMATION and Quality Authority (HIQA) has advised that a combination of MRI scans and mammography would improve detection of breast cancer in women, particularly those at high risk.
In a report by HIQA for the National Cancer Control Programme (NCCP), the authority said that a surveillance programme should be put in place to detect the cancer in women with familial or genetic risk factors.
Surveillance, as opposed to screening, is a secondary preventative measure that aims to detect breast cancer at the earliest possible stage.
In Ireland, mammography is the primary breast imaging method for screening asymptomatic women aged 50 to 64 years. It is also used for the investigation of symptomatic women and for the follow up of women with a previous history of breast cancer.
The report said that that a mammogram, which is an X-ray of the breast, is determined in density by the relationship between fat and tissue and is less sensitive if breast tissue is dense.
While MRI, which can generate multiple cross-sectional images of the breast that can be viewed in three dimensions is more sensitive, it is less specific than mammography for the target population and a combination of the two is recommended for those most at risk.
Cancer detection rates
“Combined MRI plus mammography improves sensitivity further, with a minimal decrease in specificity,” the report said.
Studies show that cancer detection rates are higher when a combination is used, rather than mammography alone, according to the report.
Unlike mammography, MRI does not involve exposure to ionising radiation. It has been reported that the sensitivity of MRI is not affected by breast tissue density to the same extent as mammography. However, hormonal factors such as menopausal status, use of hormone replacement therapy and phase of menstrual cycle have been shown to affect breast tissue enhancement.
It has been recommended that breast MRI should only be offered in institutions that can also offer MRI-guided biopsy or that are in close contact with a site that can. However access to this procedure is currently limited to four of the eight regional centres in Ireland, all in Dublin.
HIQA concluded that for women aged 30 to 49 who have been identified to be carriers of certain genetic mutations, using annual MRI scans is cost-effective. From ages 40 to 49, the addition of an annual mammogram may also be considered.
In another small cohort of women who have a high probability of breast cancer before age 30, annual MRI surveillance from age 20 to 49 is the optimal strategy recommended by HIQA.
The board of the authority has approved the report and it has been submitted to the NCCP for consideration.
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