“Early detection and treatment of breast cancer in these high-risk women are important goals, particularly if we can find a cost-effective way of achieving them,” said Anne C. Ford, MD, assistant professor of obstetrics and gynecology at Duke University Medical Center and lead author of the study. “By catching these tumors early, treatment may be less expensive than for advanced disease.”
A problem that persists in the fight against breast cancer is the disparity in death rates between blacks and whites. While African-American women are diagnosed with the disease less often, they have a disproportionately higher death rate.
Better screening programs could help by catching breast cancer tumors earlier, before they become lethal and spread.
For the Duke screening trial, a team called patient navigators went into low-income communities around Durham, NC. The navigators identified women with no health insurance or limited policies, and provided them information about breast cancer prevention and treatment.
The patients were then separated into two groups based on known breast cancer risk factors, including close family members who had been diagnosed with the disease.
Nearly 300 women — 33 percent African-American – who met the criteria for high risk were given magnetic resonance imaging (MRI) screenings. The technology is expensive, but can be more sensitive, particularly among younger women who have denser breast tissue that can pose a challenge to mammography.
Another 299 women were considered normal risk, and got traditional, less costly mammograms. Of the normal risk group, 40 percent were African-American.
Among the normal-risk trial participants, mammography detected one breast cancer case. MRI screenings turned up seven cancers in the high-risk group, demonstrating that a targeted use of MRI screenings could offer an effective approach for high-risk women.
The MRI screenings also had a lower rate of false positives than mammography. Ford said that finding is important given the tendency of MRI screenings in the general population to flag normal breast tissue as suspect, leading to unnecessary worries and costly biopsies.
“MRI really should not be a considered a standard of care for routine breast cancer screening because it is expensive and too sensitive,” Ford said. “But this study proves that if it is used in the right population, this test can be cost effective and lifesaving.”
Ford said patient navigation was the key to ensuring that patients get the right screening and follow-up.
“We actually go out to different health fairs and community events, identify women at point one, and then guide them through the process from that day onward,” said Lamisha Banks, one of the study navigators and co-authors. “We stick with them through treatment and beyond.”
In addition to Ford and Banks, study authors include: Xiomara Boyce; Stephanie Robertson; Endya Frye; Nora Tolbert; Laurie Lee; Gloria Broadwater; and Victoria L. Seewaldt.
Funding for that trial was provided by Susan G. Komen for the Cure Triangle Affiliate; AVON; the National Breast Cancer Foundation; the Breast Cancer Relief Foundation; and the Kate B. Reynolds Charitable Trust.
No authors reported conflicts of interest.