A few months ago, a close family member faced the terrifying uncertainty of finding a lump in her breasts. My relative, who had a history of dense breast tissue and had undergone multiple surgeries to remove benign lumps, found another during a routine self-exam. This was not the first time she had faced this situation; her dense breast tissue had always made it difficult for standard mammograms to give clear results. However, this time was different.
She went in for her regular mammogram and nothing was found. She pressed her doctor for further screening. First, she had an ultrasound, which led to further testing and then to an MRI.
The MRI revealed what the mammogram could not: she had breast cancer. The realization that the cancer might have gone undetected if she hadn’t pushed was a chilling thought. With any cancer diagnosis, time is of the essence and every day and every minute counts. This raised a crucial question so many women are asking: why don’t we just get MRI screenings for breast cancer?
Featured Experts
- Dr. Monica Grover is a board-certified ob-gyn and chief medical officer at VSPOT
- Jasmine Khorsandi is an ultrasound sonographer and founder of SonoBreasts
- Dr. Sheldon Feldman is the chief of the division of breast surgery and breast surgical oncology at Montefiore Einstein Comprehensive Cancer Center
The Effectiveness of MRI Screenings
MRI, or magnetic resonance imaging, is considered the gold standard in breast cancer detection, especially for women with dense breast tissue. Unlike mammograms, which rely on X-rays, MRIs use magnets and radio waves to create detailed breast images. New York gynecologist Dr. Monica Grover says MRIs are particularly effective at identifying dense tissue, where mammograms often fall short. “Tumors can look very similar to dense breast tissue on a mammogram, making it hard to distinguish between benign and malignant,” she says. While ultrasounds can detect some additional cancers, they still miss many, which is why MRIs are often preferred.”
In women with dense breasts, mammograms can miss up to 50 percent of cancers. Dr. Grover says MRIs give a clearer and more accurate picture. “The goal is to avoid unnecessary biopsies while picking up cancers earlier,” she noted.
Yet despite their superior accuracy, MRIs are not widely used as a primary screening tool. Instead, they are typically reserved for high-risk patients or those with inconclusive screenings. But why is that?
The Barriers to Regular MRI Screenings
One of the main obstacles to widespread MRI screenings is cost. MRIs are expensive, often costing several thousand dollars per scan. As Dr. Grover pointed out, “Until Congress and insurance companies decide to reduce the cost, using MRIs as a routine screening tool is just not feasible for most patients.”
Insurance coverage is another significant barrier. Many insurance companies do not approve MRIs for routine screenings, even for high-risk patients or those with a history of breast cancer. Dr. Grover says it’s really frustrating for providers. “It’s ridiculous that MRIs are still not getting approved for follow-ups for patients with a history of breast cancer. Insurance companies just automatically assume that doctors order unnecessary tests because they don’t know. They don’t have any clinical background or knowledge as to why we’re ordering the things that we do.”
This creates a challenging scenario where patients must advocate for themselves, often fighting against a system that seems designed to limit access to potentially life-saving technology. “Even when we as doctors try to do our best, the insurance companies often reject our requests. Patients need to be their own advocates, understanding their bodies and pushing for the necessary screenings,” Dr. Grover urges.
The Ultrasound Option
Gwyneth Paltrow advocates for routine ultrasound screenings between her mammograms, praising them for being radiation-free and pain-free. Unlike mammograms, which use X-ray beams (a form of ionizing radiation), ultrasounds do not involve radiation. “I like to do these in between mammograms to cover all my bases,” the Goop founder shared with her followers.
Whether considered high risk or just cautionary, ultrasound sonographer and founder of SonoBreasts, Jasmine Khorsandi, says many of her clients, including Paltrow, opt for ultrasounds between their yearly screenings for added peace of mind. “With SonoCiné, cancer can appear as a black spider against a white backdrop, highlighting the importance of advanced imaging techniques to uncover what mammograms might might miss,” Khorsandi explains.
Ultrasounds also offer advantages over MRIs, making them accessible to a broader public. “While MRIs provide detailed images, they can be intimidating due to contrast agents that might cause side effects like nausea, dizziness, or allergic reactions. They can also be expensive, and the confined space of the MRI machine can be unsettling. In contrast, ultrasounds are less expensive, typically costing a few hundred dollars, and offer a more comfortable experience without the need for contrast,” she adds.
The Future of Breast Cancer Screening
Given the clear benefits of other means of more accurate screening, why aren’t they the standard for all women? The answer lies in the complex interplay of cost, insurance and accessibility. However, there is hope on the horizon. Advances in technology and increasing awareness of the limitations of mammograms may lead to wider use of MRIs and ultrasounds in breast cancer screening.
For now, though, the key takeaway is that women need to be vigilant about their breast health. Dr. Sheldon Feldman of Montefiore Einstein Comprehensive Cancer Center stressed the importance of understanding one’s risk: “Women face a risk of breast cancer simply by virtue of having breasts, and this risk increases with age. Unfortunately, we often see cases where patients who are at high risk due to family history or other factors have never undergone genetic testing or proper screening. These individuals are frequently diagnosed with cancer only after discovering a lump rather than through proactive screening.”
Dr. Grover echoed this sentiment, stating it’s up to patients to take charge of their health. “The best advocacy a patient can do for themselves is to be proactive in their prevention, understand their body, and justify their concerns to their doctor,” she advises. “Even when we are trying as doctors to do the best that we can, and we’re still getting rejected by the insurance companies, the patient just has to keep advocating for themselves.”
