Customer-oriented breast MRI screening stirs furor
Flying in the face of conventional wisdom among U.S. radiologists, customer-oriented AmeriScan whole-body screening centers in Phoenix and San Jose, CA, are touting MR as a screening test superior to x-ray mammography for detecting breast cancer.
Several hundred women have bought the screening exams, priced at $1700 to $2200, since the for-profit company began advertising the service in July, according to medical director Dr. Craig Bittner. The ads in Phoenix and San Francisco Bay Area newspapers claim that traditional mammography misses more breast cancer than it finds, jeopardizing the lives of thousands of women, and leads to over 500,000 unnecessary and costly breast biopsies each year.
AmeriScan promotes its MRI BreastScreen as the "absolute best breast cancer screening available in the world." Bittner confirmed the claims in an interview with Diagnostic Imaging last week.
"Simply put, it is the best screening test," he said. "MR mammography has nearly 100% sensitivity and about 80% specificity for breast cancer. The MR literature shows that it is a fantastic tool. In comparison, x-ray mammography misses two of three cancers."
Bittner recruited MR mammography researcher Dr. Werner A. Kaiser, chair of the Institute of Diagnostic and Interventional Radiology at the Friedrich-Schiller University in Jena, Germany, to develop AmeriScan's program. It was launched after a year and a half of preparation, he said.
Bittner traveled to Germany for training and to read cases under Kaiser's direction. Kaiser, who serves on AmeriScan's advisory board, also spent several weeks in the U.S. this year to train technologists who perform the exam and an unnamed California-based radiologist who assists Bittner with interpretation.
In general, radiologists should not perform screening MR mammography because of its high protocol and operator dependence, according to Bittner.
"There is no other group right now that should or could offer MRI as a screening technology," he said.
Several breast imaging experts say no clinical evidence supports the use of MRI as a breast cancer screening tool in low-risk asymptomatic women.
"It's really unproven. The vast majority of published work on MRI has been done in a diagnostic setting. Nobody in the field believes that MRI should be used for breast cancer screening right now," said Dr. Susan Orel, an associate professor of radiology at the University of Pennsylvania Health System.
But MRI for breast cancer is still a growing field that is just beginning to be ready for diagnostic use, according to Orel.
"To say it is ready for breast cancer screening is getting way ahead of the current research," she said.
Some experts do credit MRI with higher sensitivity for detecting breast cancer than mammography, but not without caveats.
"MRI of the breast is the most sensitive imaging technique available for the detection and staging of breast cancer," said Dr. Christiane K. Kuhl, section chief of women's imaging at the University of Bonn in Germany. "Several trials have proved that it helps detect more breast cancer than mammography and breast ultrasound, even if the latter two are used in combination. So if costs are no consideration, MRI may well be used for breast cancer screening."
Bittner is convinced his MR screening program breaks through an institutional logjam that has barred access to what he believes is a diagnostically superior technology.
"When are we going to say that technological advancement is a good thing? We should be championing this, not trying to retard it," he said.
