On 2014 Aug 05, David Keller commented:

Women sometimes refuse mammography due to the pain it causes - how should they be screened?

In her reply to my letter (1), Dr. Hwang did not address my suggestion of using MRI to screen women who refuse compression mammography due to the pain it causes, or their wish to avoid ionizing radiation to their breasts. I pointed out that these issues affect mainly younger women who are sent for mammograms, due to their higher breast content of glandular tissue.

Dr. Hwang wrote: "Most breast cancer screening guidelines recommend against mammographic screening in women younger than 40 years owing to the low breast cancer incidence in this population”

To clarify, I agree, and I support the American Cancer Society recommendation that routine annual screening mammography should begin at age 40 (2).

Dr. Hwang wrote: “Furthermore, it has been clearly demonstrated that premenopausal women experience MRI changes with the menstrual cycle, which can often lead to false-positive MRI findings."

I agree again, and menstrual cycle variations in breast imaging characteristics (in both MRI and mammography) can and should be mitigated by the proper timing of the examination. A European guideline states: "The optimal time in pre-menopausal women to perform a breast MRI is between the 5th and 12th day after the start of the menstrual cycle during week 2 of the menstrual cycle" (3).

Most importantly, I would like to know what Dr. Hwang recommends be done to screen women who refuse mammography. If not MRI, what would she suggest?

References

1: Keller, DL. In Defense of Screening for Breast Cancer With Magnetic Resonance Imaging. JAMA Intern Med. 2014;174(8):1417. doi:10.1001/jamainternmed.2014.810.

2: American Cancer Society website, accessed on 8/4/2014 at the following URL: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs

3: Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008 Jul;18(7):1307-18. doi: 10.1007/s00330-008-0863-7. Epub 2008 Apr 4. PubMed PMID: 18389253; PubMed Central PMCID: PMC2441490.

On 2014 Aug 05, David Keller commented:

Women sometimes refuse mammography due to the pain it causes - how should they be screened?

In her reply to my letter (1), Dr. Hwang did not address my suggestion of using MRI to screen women who refuse compression mammography due to the pain it causes, or their wish to avoid ionizing radiation to their breasts. I pointed out that these issues affect mainly younger women who are sent for mammograms, due to their higher breast content of glandular tissue.

Dr. Hwang wrote: "Most breast cancer screening guidelines recommend against mammographic screening in women younger than 40 years owing to the low breast cancer incidence in this population”

To clarify, I agree, and I support the American Cancer Society recommendation that routine annual screening mammography should begin at age 40 (2).

Dr. Hwang wrote: “Furthermore, it has been clearly demonstrated that premenopausal women experience MRI changes with the menstrual cycle, which can often lead to false-positive MRI findings."

I agree again, and menstrual cycle variations in breast imaging characteristics (in both MRI and mammography) can and should be mitigated by the proper timing of the examination. A European guideline states: "The optimal time in pre-menopausal women to perform a breast MRI is between the 5th and 12th day after the start of the menstrual cycle during week 2 of the menstrual cycle" (3).

Most importantly, I would like to know what Dr. Hwang recommends be done to screen women who refuse mammography. If not MRI, what would she suggest?

References

1: Keller, DL. In Defense of Screening for Breast Cancer With Magnetic Resonance Imaging. JAMA Intern Med. 2014;174(8):1417. doi:10.1001/jamainternmed.2014.810.

2: American Cancer Society website, accessed on 8/4/2014 at the following URL: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs

3: Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008 Jul;18(7):1307-18. doi: 10.1007/s00330-008-0863-7. Epub 2008 Apr 4. PubMed PMID: 18389253; PubMed Central PMCID: PMC2441490.