29 July 2004

Detecting Breast Cancer

Nearly 2,000 Dutch women, 358 of which had a genetic and familial predisposition to breast cancer were part of a study that compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for breast cancer screening. [New England Journal of Medicine, Vol.351:427-43 July 29, 2004]

The study concluded that while routine mammography is good at detecting breast cancer, MRI is better at detecting breast cancer at an early stage in women at risk.

While most doctors will say that MRI the most cost-effective, I think it is still prohibitive, as only a few can afford it. If mammography is not giving your physician the details he need to manage your case, he will usually request for MRI. In the US, an MRI scan costs $700 to $1,000 --- about 10 times the cost of a mammogram, and this also true here in the Philippines. Depending on the hospital chosen, MRI for breast cancer screening range anywhere from P12,000 to P16,000 with a preparation guideline asking that the procedure be done 6-17 days after the menstruation period.

The average lifetime risk of breast cancer in an American woman is 1 in 7. In women who have a history of breast cancer, atypia or lobular carcinoma-in-situ, or a strong family history of breast cancer, this risk increases.

Studies have also shown that women with inherited mutations of the BRCA1 or BRCA2 gene (breast cancer genes) have the highest risk of breast cancer. They make up 5-10% of women with breast cancer and are also at increased risk for ovarian cancer.

A sad fact is that the "highest breast cancer incidence rates in Southeast Asia have been reported for the Manila Cancer Registry in the Philippines, with an age-standardized rate of 47.7 per 100,000 per year." [Int J Cancer. 2002 Apr 1;98(4):596-603]

With a high preponderance of the BRCA2 and BRCA1 mutations among women studied in the Philipines (BRCA2 greater than BRCA1), and this latest finding that MRI screening is better than routine mammography, what good is this study for affected Filipino women if they cannot afford it?

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