This study looked at 1909 women with a familial or genetic predisposition to breast cancer, and compared MRI screening versus mammographic screening. The study found that the MRI was much more sensitive than mammography (79.5% vs 33.3%), while only a bit less specific (89.8% vs 95.0%). COMMENT: the policy of the NEJM not to publish full journal content harms the poorest people in the world. Those least able to afford to pay, are forced to pay by a company located in perhaps the richest part of the richest country of the world (New England region of the US). We cannot look into the guts of this article because only the abstract is provided free online. So, in this group of women, we can only say that the MRI scan looks promising. But who should get one instead of a mammogram? What about PET or SPECT Tc-sestamibi scanning? Who gets a PET scan instead of a colonoscopy (for colon cancer), chest x-ray (or chest CT for lung cancer), or mammogram (or MRI for breast cancer)? The PET scan would screen for all of the above in one single scan, it is noninvasive, and in the long run would likely save money.

Mieke Kriege, M.Sc., Cecile T.M. Brekelmans, M.D., Ph.D., Carla Boetes, M.D., Ph.D., Peter E. Besnard, M.D., Ph.D., Harmine M. Zonderland, M.D., Ph.D., Inge Marie Obdeijn, M.D., Radu A. Manoliu, M.D., Ph.D., Theo Kok, M.D., Ph.D., Hans Peterse, M.D., Madeleine M.A. Tilanus-Linthorst, M.D., Sara H. Muller, M.D., Ph.D., Sybren Meijer, M.D., Ph.D., Jan C. Oosterwijk, M.D., Ph.D., Louk V.A.M. Beex, M.D., Ph.D., Rob A.E.M. Tollenaar, M.D., Ph.D., Harry J. de Koning, M.D., Ph.D., Emiel J.T. Rutgers, M.D., Ph.D., Jan G.M. Klijn, M.D., Ph.D., for the Magnetic Resonance Imaging Screening Study Group


EMIEL RUTGERS


RADU MANOLIU

http://content.nejm.org/cgi/content/short/351/5/427

NEJM Volume 351:427-437 July 29, 2004 Number 5