Breast MRI

Policy context

Magnetic resonance imaging (MRI) of the breast used in diagnosis and treatment of cancer has been selected for review. Concern about safety, cost, and efficacy regarding the use of MRI to screen women at high risk for breast cancer, with the goal of providing early diagnosis and reducing the mortality rate associated with breast cancer.

Status: Decision completed

Primary criteria ranking

  • Safety = Low
  • Efficacy = Medium
  • Cost = High
Documents

Assessment timeline

  • Draft report published: June 25, 2010 
  • Public comment period: June 25 to July 16, 2010 
  • Final report published: July 21, 2010 
  • HTCC public meeting: August 20, 2010

Background

Breast cancer is the second most common malignancy affecting women, and is an important public health concern. Accurate diagnosis and appropriate treatment are critical. Patients identified as having a possible abnormality on screening mammography or physical examination or who are at high risk may undergo additional tests, including imaging, and physical examination. An ideal diagnostic test to evaluate risk/breast abnormalities would provide accurate information appropriate to guide patient-management decisions. Such test would accurately distinguish patients who need to have a biopsy from those who can safely avoid one as well as accurately identify extent or location of malignancy (e.g. detection of contra lateral disease) for optimizing treatment. In order to appropriately guide decisions, a person who has a negative test result should be very confident that the result is correct.

Breast MRI is being investigated as an adjunct to mammography for screening of high-risk women since its accuracy is not affected by breast density, it does not use radiation, and it has high sensitivity. Important questions include the how accurate breast MRI is in detecting breast cancer compared with conventional screening techniques; does screening with a breast MRI as a supplement to mammography reduce morbidity or mortality; and have a definitive patient selection criteria for the use of breast MRI screening and staging in women at high risk for the disease been established?