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In the Netherlands, women from the age of fifty receive a call for the breast cancer population screening
The European Society of Breast Radiology has published new recommendations for screening women with extremely dense breast tissue. The association is thus moving away from the uniform approach of biennial mammography, which is currently the standard for European breast cancer screening organizations. They argue for a more person-oriented approach, in which the composition of the breasts and the wishes of the woman receive more attention.
In the Netherlands, women from the age of fifty receive a call for the breast cancer screening programme. They receive a mammography, an X-ray of the breasts, with which a radiologist detects abnormalities. The breasts mainly consist of fat, connective tissue and glandular tissue. Eight percent of all women have breasts with an extremely high amount of glandular tissue, so-called dense breasts. In this group, the risk of breast cancer is twice as high as for the average woman, so the population screening is extra important for them. But mammography does not work well with dense breasts.
The European Association for Breast Radiology (EUSOBI) has now come up with a new European recommendation, in which they recommend an MRI scan instead of a mammography for the group of women with dense breasts. Ritse Mann, radiologist at Radboudumc and first author of this recommendation, explains why an MRI scan works better: ‘On images of a mammogram, adipose tissue is black and glandular tissue is white. But a tumor also turns white. That is why you look for a white tumor in a white background with a lot of glandular tissue and that is very difficult. An MRI scan then gives much more contrast.’
Better detection
The aim of the new European guideline is twofold, says Ritse Mann: ‘First of all, we want to ensure that women are informed about the amount of glandular tissue in their breasts. That is not yet the case as standard. Secondly, the MRI scan should be made available throughout Europe for women with dense breasts. I think it is important that we offer all imaging techniques that have been proven to work, and that women receive good information about the available options and the advantages and disadvantages. Women should be able to decide more for themselves whether and how they want to be examined.’
The new recommendation for MRI is largely based on the DENSE study, which was conducted in eight Dutch hospitals. In this study the value of the MRI scan was investigated in women with dense breasts. This showed that the MRI scan saves lives in this group by improving the detection of cancer. The number of women who died of breast cancer decreased by 40 percent, according to the modeling of the study. Women would live an average of 15 years longer in good health if the breast cancer was detected with MRI. In addition, the scan turned out to be cost-effective.
Make more decisions for yourself
A disadvantage of MRI is that the scan detects more abnormalities that turn out to be harmless during follow-up examination. In addition, an MRI scan takes a little longer than a mammography and requires the injection of a contrast agent. The Health Council has therefore previously issued a recommendation against the MRI scan. Ritse Mann: ‘I think they ignore the fact that women want to know for sure whether they have breast cancer, and take an extra examination for granted. Of course that is annoying and there are also women who therefore do not allow themselves to be examined. That is their right and they can always decide for themselves.’
With the guideline, the European association recognizes the value of the MRI scan and focuses on more person-oriented care. Ritse Mann: ‘Breast cancer screening works well in itself and has already saved many lives. But it’s still too much one-size-fits-all. I think we should focus more on risk assessment and then adjust the screening for each individual. That means you want to examine some women more often, and others less often. We can also better tailor the technique used to the composition of the breasts and other risk factors. These new recommendations are a good step in that direction.’
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- Name author and/or edited by: Radboudumc
- Photographer or photo agency: : INGImages
- Source for this article: : Radboudumc
- What is the URL for this resource?: https://www.radboudumc.nl/nieuws/2022/europese-richtlijn-adviseert-mri-screening-bij-vrouwen-met-dicht-borstweefsel
- Original title: European guideline recommends MRI screening in women with dense breast tissue
- Target audience: Healthcare professionals
- Date: 2022-03-15