David A. Strahle MD, Presenter: Nothing to Disclose

1) Explain the role dense fibroglandular tissue plays in hiding breast cancer. 2) List four advantages Screening Breast MRI has over screening mammograms. 3) Discuss how often Screening Breast MRI’s should be obtained on a routine basis in women with dense breast tissue. 4) Discuss the impact a national MRI screening program might have on saving lives and reducing costs. 5) Identify eight financial advantages for insurance carriers who pay for annual Screening Breast MRI's.

Mammograms have been the only screening imaging modality accepted for early detection of breast cancer for almost 50 years.  Historically, Breast MRI has been used to define the extent of breast cancer only after identification by mammograms. Our research used Breast MRI to determine the presence of occult cancers missed by screening mammograms and the relationship of those cancers to dense breast tissue.  In addition, we were able to identify a limited number of MRI sequences that are now being used for annual screening of women who have dense breasts without any other breast abnormalities. For two years, 671 women received a Breast MRI at no cost following a negative screening mammogram.  Eighteen parameters were recorded including the density of her fibroglandular tissue and the location of any lesions inside or outside the fibroglandular tissue. Numerous lesions (benign and malignant) missed by mammography were clearly identified by MRI.  MRI detected cancer at a rate of 16.3 per 1000 women verses the mammogram detection rate of 2.7 per 1000 women.  This correlates to a major shift in time of cancer detection 6 years earlier than screening the same women with mammography. Only 3 different MRI sequences detected all the cancers reducing scan time to only 12 minutes.  Further, we were able to reduce unnecessary biopsies significantly below that of mammography. As a result of our research, effective November 18, 2013, the first insurance carrier in the nation began paying for annual Screening Breast MRI's for all women with dense breast tissue between 40 and 80 years of age.  They have estimated significant savings across eight major financial categories.  In addition, lives saved due to super-early detection are expected to be high resulting in a major marketing advantage for the insurance industry.  

http://media.rsna.org/media/abstract/2014/14000939/MSRT44 sec.pdf

Strahle, D, ASRT@RSNA 2014: The Miracle of Breast MRI.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000939.html