How do the current and latest techniques stack up?
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MAMMOGRAMS
— the current gold standard for breast cancer screening MAGNETIC RESONANCE
IMAGING (MRI) — sometimes used as an adjunct to mammography SELF-BREAST EXAMINATION
(SBE) — puts patient screening in their own hands, literally NUCLEAR SCREENING
(SCINTIMAMMOGRAPHY AND POSITIVE EMISSION TOMOGRAPHY SCANNING) — can be helpful
when combined with other techniques • Mammography is backed by a large body
of scientific evidence. • There are no absolute contraindications against
this method. • Studies show low cost:benefit ratios. • MRI appears to
be more sensitive than mammography for detecting cancerous lesions, especially
when they’re small. • It can be argued that it’s better than mammography
for distinguishing between cancerous and non-cancerous lesions. • It’s
less painful than mammography. MRI is especially useful in patients at high risk
(ie, those with a strong familial history). In fact, evidence suggests that MRI
may be more cost-effective than mammography in high-risk women. • The primary
advantage of SBE is that it allows for monthly evaluations at no financial cost.
• SBE programs increase patient awareness of breast cancer screening and
risks. • The combination of SBE and mammography has been shown to decrease
mortality rates. • SBE is convenient and painless. • Nuclear screening
tests (NSTs) are relatively sensitive. • They detect changes in regional
blood flow and are potentially useful adjuncts to conventional methods that only
detect anatomic changes. • This type of screen may identify local and distant
malignant spread, which could reduce the number of unnecessary mastectomies. •
NSTs may be particularly useful for screening high-risk individuals. • Sensitivity
is low compared to other imaging modalities. • Specificity is generally low,
but this is true of virtually all current screening measures. • Diagnostic
accuracy is compromised in individuals with dense, glandular breasts. • The
procedure is more painful than other tests. • Specificity for breast cancers
is relatively low, which may result in unnecessary biopsies. • There are
several absolute contraindications for MRI, including pacemakers and surgical
clips. • Claustrophobia prohibits many patients from submitting to MRI. •
There’s relatively little research evidence supporting its use as a screening
tool. • Self-exam is the least sensitive and specific screen. • It’s
of questionable benefit when not combined with mammography. On its own, it doesn’t
reduce breast cancer mortality. • SBE is highly non-specific in patients
with dense, glandular breasts. • NSTs are relatively non-specific. •
The procedures are necessarily invasive — they require intravenous injections
of radioactive tracer materials. • There’s less evidence supporting
the use of NSTs for breast cancer screening than any of the previously listed
methods. • Mammograms are readily available across Canada and are performed
in virtually all radiology departments. • Many communities and hospitals
don’t have this technology. • Waiting lists can be up to a year or more
for elective MRI. • Access is virtually universal since patients perform
SBE on themselves. • Anyone who can unhook a bra can perform SBE. •
Access to NSTs is more limited than SBE or mammography. • Only larger hospitals
have nuclear medicine departments. • Waiting lists vary from weeks to months.
• In Ontario, the technical cost is $37.70 for bilateral breast mammography.
• The professional cost for reading mammograms is $21.50 per patient. •
Costs are relatively high. In Ontario, the professional cost for reading MRI of
the thorax is $74.05 with $37.05 added for additional views. • The only cost
is in patient time and effort. • Direct costs of NSTs are greater than SBE
or mammography. • In Ontario, the professional cost for an NST reading is
$43.90. • The Ministry of Health Schedule of Benefits does not list technical
costs for either of these procedures but they should fall between $150 to $2000,
depending on a variety of factors, including size of area being visualized, size
of patient, etc.
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