American Association for Cancer Research (AACR): The Science of Cancer Health Disparities

WASHINGTON – An assay that can detect the presence of epidermal growth factor receptor mutations in non–small cell lung cancer patients is being vastly underused in the United States, according to a study presented at the conference sponsored by the American Association for Cancer Research.

An EGFR diagnostic was launched by Genzyme Corp. in 2005. Patients with EGFR mutations generally respond better to certain therapies – such as erlotinib (Tarceva) and geftinib (Iressa) – that target these mutations.

Earlier this year, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommended EGFR testing for lung cancer patients. ASCO’s provisional clinical opinion advocated that patients with advanced NSCLC who were being considered for treatment with a tyrosine kinase inhibitor should be tested for EGFR mutations. The NCCN called for EGFR testing after histologic diagnosis of adenocarcinoma, large cell carcinoma, or undifferentiated carcinoma, but not in patients with squamous cell disease which is less likely to be EGFR positive.

And yet, it appears that the assay is not being widely used, said Julie Lynch, R.N., a research assistant at the University of Massachusetts, Boston, who conducted the study.

After conducting a systematic review of erlotinib trials, Ms. Lynch, a PhD nursing candidate, was concerned that few blacks or Hispanics were enrolled. She decided to determine whether minorities might not be included because they were not being tested for the EGFR mutations.

Genzyme agreed to share the data it had with Ms. Lynch. The Genzyme database represents an estimated 98% of community hospital use of the EGFR assay. However, it does not present a comprehensive picture. Ms. Lynch had very little data from the 59 cancer centers with special designation from the National Cancer Institute. Many of these NCI centers have separate licenses from Genzyme or conduct their own assays for research purposes.

To get a better picture of where these tests were being used, she merged Genzyme’s data on EGFR testing with six public data sets, from the U.S. Census Bureau, the Centers for Disease Control and Prevention, the National Institute of Standards and Technology, the Centers for Medicare and Medicaid Services, and the NCI. She linked test orders to specific providers to create a nationwide map that shows county-by-county use of EGFR testing.

Ms. Lynch found that in 2010, some 6,056 tests were ordered by acute care hospitals, 93 by federal hospitals (primarily Veterans Affairs hospitals), 527 by pathology labs, and 258 by independent outpatient oncology clinics or physicians. She was able to ascertain that some 1,019 EGFR tests were ordered by NCI centers, but again, this is likely only a partial tally.

To put these numbers in perspective, the American Cancer Society estimates that there will be about 221,130 new cases diagnosed in 2011 for all types of lung cancer combined. Non–small cell lung cancers account for 80%-90% of all lung cancers.

Test orders seemed to be clustered around NCI-designated centers, Ms. Lynch said in an interview. Most likely, community hospitals that were within a relatively close distance to those NCI centers ordered more EGFR tests to compete.

Her data showed huge regional variations in EGFR use. The test was ordered in only 357 of the 3,142 counties in the United States. The largest concentrations were in Nassau County, N.Y.; New York County, N.Y.; Baltimore County, Md.; Kent County, Mich.; and Cook County, Ill. Also in the top 10 were Brooklyn, N.Y., and the counties surrounding Phoenix, Boston, Miami, and Los Angeles. Most of those top users were very close to an NCI-designated center.

When Ms. Lynch excluded the tests ordered by NCI centers, she found a bleak picture: Not a single test was ordered in Alaska; there is no NCI-designated center in that state. Only one test was ordered in Montana, one in Vermont and two in Wyoming; there are no NCI centers in those states. Only five tests were ordered in Utah, despite the presence of the Huntsman Cancer Institute at the University of Utah in Salt Lake City.

Only six tests were ordered in Arkansas and six in New Mexico.

The top states for EGFR use were Illinois (272 tests), Maryland (284), Massachusetts (334), Pennsylvania (338), California (352), Florida (496), and New York (1,024).

She found that the counties with the highest lung cancer incidence have the lowest rate of EGFR use. It’s also apparent that minorities and people with a lower socioeconomic and educational status, or those who live in rural areas, are not getting access to the EGFR test, said Ms. Lynch.

She is currently accumulating Medicare-specific data for EGFR testing, which, along with the Genzyme data, should give a complete picture. The federal health program began reimbursing EGFR testing in 2009.

Ms. Lynch ruled out reimbursement issues and technological constraints as factors in underuse of the tests, but acknowledged that even with Medicare coverage, it could be an expensive proposition for a beneficiary, as they have a 20% copay. The test costs $600-$800, she said.

EGFR testing needs to be more widespread, said Ms. Lynch, noting that not only does it help patients get the best treatment, but that it also provides crucial data for the development of new therapies.

The study was funded by grants from the U.S. Department of Education and the National Institutes of Health, and was aided by the provision of data by Genzyme Genetics. Ms. Lynch is a former employee of Genentech Corp.

WASHINGTON – An assay that can detect the presence of epidermal growth factor receptor mutations in non–small cell lung cancer patients is being vastly underused in the United States, according to a study presented at the conference sponsored by the American Association for Cancer Research.

An EGFR diagnostic was launched by Genzyme Corp. in 2005. Patients with EGFR mutations generally respond better to certain therapies – such as erlotinib (Tarceva) and geftinib (Iressa) – that target these mutations.

Earlier this year, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommended EGFR testing for lung cancer patients. ASCO’s provisional clinical opinion advocated that patients with advanced NSCLC who were being considered for treatment with a tyrosine kinase inhibitor should be tested for EGFR mutations. The NCCN called for EGFR testing after histologic diagnosis of adenocarcinoma, large cell carcinoma, or undifferentiated carcinoma, but not in patients with squamous cell disease which is less likely to be EGFR positive.

And yet, it appears that the assay is not being widely used, said Julie Lynch, R.N., a research assistant at the University of Massachusetts, Boston, who conducted the study.

After conducting a systematic review of erlotinib trials, Ms. Lynch, a PhD nursing candidate, was concerned that few blacks or Hispanics were enrolled. She decided to determine whether minorities might not be included because they were not being tested for the EGFR mutations.

Genzyme agreed to share the data it had with Ms. Lynch. The Genzyme database represents an estimated 98% of community hospital use of the EGFR assay. However, it does not present a comprehensive picture. Ms. Lynch had very little data from the 59 cancer centers with special designation from the National Cancer Institute. Many of these NCI centers have separate licenses from Genzyme or conduct their own assays for research purposes.

To get a better picture of where these tests were being used, she merged Genzyme’s data on EGFR testing with six public data sets, from the U.S. Census Bureau, the Centers for Disease Control and Prevention, the National Institute of Standards and Technology, the Centers for Medicare and Medicaid Services, and the NCI. She linked test orders to specific providers to create a nationwide map that shows county-by-county use of EGFR testing.

Ms. Lynch found that in 2010, some 6,056 tests were ordered by acute care hospitals, 93 by federal hospitals (primarily Veterans Affairs hospitals), 527 by pathology labs, and 258 by independent outpatient oncology clinics or physicians. She was able to ascertain that some 1,019 EGFR tests were ordered by NCI centers, but again, this is likely only a partial tally.

To put these numbers in perspective, the American Cancer Society estimates that there will be about 221,130 new cases diagnosed in 2011 for all types of lung cancer combined. Non–small cell lung cancers account for 80%-90% of all lung cancers.

Test orders seemed to be clustered around NCI-designated centers, Ms. Lynch said in an interview. Most likely, community hospitals that were within a relatively close distance to those NCI centers ordered more EGFR tests to compete.

Her data showed huge regional variations in EGFR use. The test was ordered in only 357 of the 3,142 counties in the United States. The largest concentrations were in Nassau County, N.Y.; New York County, N.Y.; Baltimore County, Md.; Kent County, Mich.; and Cook County, Ill. Also in the top 10 were Brooklyn, N.Y., and the counties surrounding Phoenix, Boston, Miami, and Los Angeles. Most of those top users were very close to an NCI-designated center.

When Ms. Lynch excluded the tests ordered by NCI centers, she found a bleak picture: Not a single test was ordered in Alaska; there is no NCI-designated center in that state. Only one test was ordered in Montana, one in Vermont and two in Wyoming; there are no NCI centers in those states. Only five tests were ordered in Utah, despite the presence of the Huntsman Cancer Institute at the University of Utah in Salt Lake City.

Only six tests were ordered in Arkansas and six in New Mexico.

The top states for EGFR use were Illinois (272 tests), Maryland (284), Massachusetts (334), Pennsylvania (338), California (352), Florida (496), and New York (1,024).

She found that the counties with the highest lung cancer incidence have the lowest rate of EGFR use. It’s also apparent that minorities and people with a lower socioeconomic and educational status, or those who live in rural areas, are not getting access to the EGFR test, said Ms. Lynch.

She is currently accumulating Medicare-specific data for EGFR testing, which, along with the Genzyme data, should give a complete picture. The federal health program began reimbursing EGFR testing in 2009.

Ms. Lynch ruled out reimbursement issues and technological constraints as factors in underuse of the tests, but acknowledged that even with Medicare coverage, it could be an expensive proposition for a beneficiary, as they have a 20% copay. The test costs $600-$800, she said.

EGFR testing needs to be more widespread, said Ms. Lynch, noting that not only does it help patients get the best treatment, but that it also provides crucial data for the development of new therapies.

The study was funded by grants from the U.S. Department of Education and the National Institutes of Health, and was aided by the provision of data by Genzyme Genetics. Ms. Lynch is a former employee of Genentech Corp.

WASHINGTON – An assay that can detect the presence of epidermal growth factor receptor mutations in non–small cell lung cancer patients is being vastly underused in the United States, according to a study presented at the conference sponsored by the American Association for Cancer Research.

An EGFR diagnostic was launched by Genzyme Corp. in 2005. Patients with EGFR mutations generally respond better to certain therapies – such as erlotinib (Tarceva) and geftinib (Iressa) – that target these mutations.

Earlier this year, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommended EGFR testing for lung cancer patients. ASCO’s provisional clinical opinion advocated that patients with advanced NSCLC who were being considered for treatment with a tyrosine kinase inhibitor should be tested for EGFR mutations. The NCCN called for EGFR testing after histologic diagnosis of adenocarcinoma, large cell carcinoma, or undifferentiated carcinoma, but not in patients with squamous cell disease which is less likely to be EGFR positive.

And yet, it appears that the assay is not being widely used, said Julie Lynch, R.N., a research assistant at the University of Massachusetts, Boston, who conducted the study.

After conducting a systematic review of erlotinib trials, Ms. Lynch, a PhD nursing candidate, was concerned that few blacks or Hispanics were enrolled. She decided to determine whether minorities might not be included because they were not being tested for the EGFR mutations.

Genzyme agreed to share the data it had with Ms. Lynch. The Genzyme database represents an estimated 98% of community hospital use of the EGFR assay. However, it does not present a comprehensive picture. Ms. Lynch had very little data from the 59 cancer centers with special designation from the National Cancer Institute. Many of these NCI centers have separate licenses from Genzyme or conduct their own assays for research purposes.

To get a better picture of where these tests were being used, she merged Genzyme’s data on EGFR testing with six public data sets, from the U.S. Census Bureau, the Centers for Disease Control and Prevention, the National Institute of Standards and Technology, the Centers for Medicare and Medicaid Services, and the NCI. She linked test orders to specific providers to create a nationwide map that shows county-by-county use of EGFR testing.

Ms. Lynch found that in 2010, some 6,056 tests were ordered by acute care hospitals, 93 by federal hospitals (primarily Veterans Affairs hospitals), 527 by pathology labs, and 258 by independent outpatient oncology clinics or physicians. She was able to ascertain that some 1,019 EGFR tests were ordered by NCI centers, but again, this is likely only a partial tally.

To put these numbers in perspective, the American Cancer Society estimates that there will be about 221,130 new cases diagnosed in 2011 for all types of lung cancer combined. Non–small cell lung cancers account for 80%-90% of all lung cancers.

Test orders seemed to be clustered around NCI-designated centers, Ms. Lynch said in an interview. Most likely, community hospitals that were within a relatively close distance to those NCI centers ordered more EGFR tests to compete.

Her data showed huge regional variations in EGFR use. The test was ordered in only 357 of the 3,142 counties in the United States. The largest concentrations were in Nassau County, N.Y.; New York County, N.Y.; Baltimore County, Md.; Kent County, Mich.; and Cook County, Ill. Also in the top 10 were Brooklyn, N.Y., and the counties surrounding Phoenix, Boston, Miami, and Los Angeles. Most of those top users were very close to an NCI-designated center.

When Ms. Lynch excluded the tests ordered by NCI centers, she found a bleak picture: Not a single test was ordered in Alaska; there is no NCI-designated center in that state. Only one test was ordered in Montana, one in Vermont and two in Wyoming; there are no NCI centers in those states. Only five tests were ordered in Utah, despite the presence of the Huntsman Cancer Institute at the University of Utah in Salt Lake City.

Only six tests were ordered in Arkansas and six in New Mexico.

The top states for EGFR use were Illinois (272 tests), Maryland (284), Massachusetts (334), Pennsylvania (338), California (352), Florida (496), and New York (1,024).

She found that the counties with the highest lung cancer incidence have the lowest rate of EGFR use. It’s also apparent that minorities and people with a lower socioeconomic and educational status, or those who live in rural areas, are not getting access to the EGFR test, said Ms. Lynch.

She is currently accumulating Medicare-specific data for EGFR testing, which, along with the Genzyme data, should give a complete picture. The federal health program began reimbursing EGFR testing in 2009.

Ms. Lynch ruled out reimbursement issues and technological constraints as factors in underuse of the tests, but acknowledged that even with Medicare coverage, it could be an expensive proposition for a beneficiary, as they have a 20% copay. The test costs $600-$800, she said.

EGFR testing needs to be more widespread, said Ms. Lynch, noting that not only does it help patients get the best treatment, but that it also provides crucial data for the development of new therapies.

The study was funded by grants from the U.S. Department of Education and the National Institutes of Health, and was aided by the provision of data by Genzyme Genetics. Ms. Lynch is a former employee of Genentech Corp.

WASHINGTON – A combination of risk factors may be driving a large increase in liver cancer among Latinos in the United States, researchers said at a conference sponsored by the American Association for Cancer Research.

Although liver cancer, or hepatocellular carcinoma (HCC), is most common in Asia and Africa, the incidence is on the rise in the United States, primarily due to hepatitis C virus infection. There are 20,000 new HCC cases in this country each year, and liver cancer is the fifth most common cancer in men and the seventh most common in women, according to a recent review article in the New England Journal of Medicine (2011;365:1118-27).

The main risk factors for HCC in Africa and Asia have been infection with hepatitis B or hepatitis C, and alcoholic liver disease. More recently, evidence has suggested that fatty liver disease and metabolic syndrome may be significant risk factors in Western countries, according to the NEJM review.

In the United States, HCC incidence was 1.7 cases per 100,000 in 1980, but by 2005, this figure had increased to 5 per 100,000, noted the lead author of the Texas study, Amelie Ramirez, Dr.P.H., who presented the data at the conference. Dr. Ramirez, director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio, and her colleagues decided to see if they could tease out some risk factors for HCC and thereby help to explain the increase among Latinos living in that state.

The investigators used data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program, the Texas Cancer Registry, and the Texas Department of State Health Services. They examined the time period 1995-2006 and calculated age-adjusted and age-specific HCC incidence rates as well as the prevalence of obesity, diabetes, heavy alcohol use, and smoking.

Dr. Ramirez and her colleagues found that Latinos accounted for one third of HCC cases in Texas, and about 75% of cases in South Texas. The rates were 10.6 cases per 100,000 in South Texas and 9.7 per 100,000 in the state, compared with 7.5 per 100,000 among Latinos nationally in the SEER database. About 70% of cases were in men, an observation that held across all three populations – SEER, Texas, and South Texas.

Latinos are the fastest-growing U.S. minority group, accounting for 20% of the total U.S. population and 36% of the population of Texas; by the year 2030, Latinos will constitute a majority of Texas’ census, Dr. Ramirez noted (U.S. Census Bureau, 2010). This pattern is especially pronounced in South Texas, a large region that is currently almost 70% Latino.

The researchers also documented increases in the prevalence of obesity and diabetes among Texas and South Texas Latinos. When they analyzed the time periods 1995-1997 and 2004-2006 separately, the researchers found that obesity for all Latinos increased. During 2004-2006, Texas and South Texas Latinos had higher rates of obesity than U.S. Latinos overall. For U.S. Latinos, the obesity rate was 27%, compared with 30% for Texas Latinos and 35% for South Texas Latinos.

Diabetes prevalence also increased among U.S. Latinos overall, while the prevalence figures for South Texas and Texas Latinos showed increases, but they were not significant.

Heavy alcohol use and smoking did not appear to be significant risk factors for HCC in the analyses. However, the study shows that obesity and diabetes, both of which are preventable and treatable, should receive more attention in the Latino population, especially in Texas, Dr. Ramirez said.

WASHINGTON – A combination of risk factors may be driving a large increase in liver cancer among Latinos in the United States, researchers said at a conference sponsored by the American Association for Cancer Research.

Although liver cancer, or hepatocellular carcinoma (HCC), is most common in Asia and Africa, the incidence is on the rise in the United States, primarily due to hepatitis C virus infection. There are 20,000 new HCC cases in this country each year, and liver cancer is the fifth most common cancer in men and the seventh most common in women, according to a recent review article in the New England Journal of Medicine (2011;365:1118-27).

The main risk factors for HCC in Africa and Asia have been infection with hepatitis B or hepatitis C, and alcoholic liver disease. More recently, evidence has suggested that fatty liver disease and metabolic syndrome may be significant risk factors in Western countries, according to the NEJM review.

In the United States, HCC incidence was 1.7 cases per 100,000 in 1980, but by 2005, this figure had increased to 5 per 100,000, noted the lead author of the Texas study, Amelie Ramirez, Dr.P.H., who presented the data at the conference. Dr. Ramirez, director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio, and her colleagues decided to see if they could tease out some risk factors for HCC and thereby help to explain the increase among Latinos living in that state.

The investigators used data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program, the Texas Cancer Registry, and the Texas Department of State Health Services. They examined the time period 1995-2006 and calculated age-adjusted and age-specific HCC incidence rates as well as the prevalence of obesity, diabetes, heavy alcohol use, and smoking.

Dr. Ramirez and her colleagues found that Latinos accounted for one third of HCC cases in Texas, and about 75% of cases in South Texas. The rates were 10.6 cases per 100,000 in South Texas and 9.7 per 100,000 in the state, compared with 7.5 per 100,000 among Latinos nationally in the SEER database. About 70% of cases were in men, an observation that held across all three populations – SEER, Texas, and South Texas.

Latinos are the fastest-growing U.S. minority group, accounting for 20% of the total U.S. population and 36% of the population of Texas; by the year 2030, Latinos will constitute a majority of Texas’ census, Dr. Ramirez noted (U.S. Census Bureau, 2010). This pattern is especially pronounced in South Texas, a large region that is currently almost 70% Latino.

The researchers also documented increases in the prevalence of obesity and diabetes among Texas and South Texas Latinos. When they analyzed the time periods 1995-1997 and 2004-2006 separately, the researchers found that obesity for all Latinos increased. During 2004-2006, Texas and South Texas Latinos had higher rates of obesity than U.S. Latinos overall. For U.S. Latinos, the obesity rate was 27%, compared with 30% for Texas Latinos and 35% for South Texas Latinos.

Diabetes prevalence also increased among U.S. Latinos overall, while the prevalence figures for South Texas and Texas Latinos showed increases, but they were not significant.

Heavy alcohol use and smoking did not appear to be significant risk factors for HCC in the analyses. However, the study shows that obesity and diabetes, both of which are preventable and treatable, should receive more attention in the Latino population, especially in Texas, Dr. Ramirez said.

WASHINGTON – A combination of risk factors may be driving a large increase in liver cancer among Latinos in the United States, researchers said at a conference sponsored by the American Association for Cancer Research.

Although liver cancer, or hepatocellular carcinoma (HCC), is most common in Asia and Africa, the incidence is on the rise in the United States, primarily due to hepatitis C virus infection. There are 20,000 new HCC cases in this country each year, and liver cancer is the fifth most common cancer in men and the seventh most common in women, according to a recent review article in the New England Journal of Medicine (2011;365:1118-27).

The main risk factors for HCC in Africa and Asia have been infection with hepatitis B or hepatitis C, and alcoholic liver disease. More recently, evidence has suggested that fatty liver disease and metabolic syndrome may be significant risk factors in Western countries, according to the NEJM review.

In the United States, HCC incidence was 1.7 cases per 100,000 in 1980, but by 2005, this figure had increased to 5 per 100,000, noted the lead author of the Texas study, Amelie Ramirez, Dr.P.H., who presented the data at the conference. Dr. Ramirez, director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio, and her colleagues decided to see if they could tease out some risk factors for HCC and thereby help to explain the increase among Latinos living in that state.

The investigators used data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program, the Texas Cancer Registry, and the Texas Department of State Health Services. They examined the time period 1995-2006 and calculated age-adjusted and age-specific HCC incidence rates as well as the prevalence of obesity, diabetes, heavy alcohol use, and smoking.

Dr. Ramirez and her colleagues found that Latinos accounted for one third of HCC cases in Texas, and about 75% of cases in South Texas. The rates were 10.6 cases per 100,000 in South Texas and 9.7 per 100,000 in the state, compared with 7.5 per 100,000 among Latinos nationally in the SEER database. About 70% of cases were in men, an observation that held across all three populations – SEER, Texas, and South Texas.

Latinos are the fastest-growing U.S. minority group, accounting for 20% of the total U.S. population and 36% of the population of Texas; by the year 2030, Latinos will constitute a majority of Texas’ census, Dr. Ramirez noted (U.S. Census Bureau, 2010). This pattern is especially pronounced in South Texas, a large region that is currently almost 70% Latino.

The researchers also documented increases in the prevalence of obesity and diabetes among Texas and South Texas Latinos. When they analyzed the time periods 1995-1997 and 2004-2006 separately, the researchers found that obesity for all Latinos increased. During 2004-2006, Texas and South Texas Latinos had higher rates of obesity than U.S. Latinos overall. For U.S. Latinos, the obesity rate was 27%, compared with 30% for Texas Latinos and 35% for South Texas Latinos.

Diabetes prevalence also increased among U.S. Latinos overall, while the prevalence figures for South Texas and Texas Latinos showed increases, but they were not significant.

Heavy alcohol use and smoking did not appear to be significant risk factors for HCC in the analyses. However, the study shows that obesity and diabetes, both of which are preventable and treatable, should receive more attention in the Latino population, especially in Texas, Dr. Ramirez said.

WASHINGTON – Magnetic resonance imaging screening for breast cancer is feasible and cost effective for high-risk underserved women, according to a study conducted by Duke University Medical Center researchers.

The investigators, led by Dr. Anne C. Ford, assistant professor of obstetrics and gynecology at the center, wanted to determine whether targeting MRI screening, which has the potential to increase the number of benign biopsies, would increase costs.

The researchers included 299 women who participate in a high-risk clinic at Duke, who were given a digital mammogram followed by an MRI, as well as 299 average-risk women recruited through an outreach program to serve as controls. High risk was defined as a greater than 20% lifetime risk of breast cancer, the investigators reported at a conference sponsored by the American Association for Cancer Research.

The women were racially diverse. The mammography group was 40% African American, 25% white, 25% Hispanic, and 10% other. The MRI group was 62% white, 33% African American, 3% Hispanic, and 2% other.

Women found to have an abnormal mammogram were evaluated by ultrasound, ultrasound-guided biopsy, and/or stereotactic biopsy. Women with an abnormal breast MRI were evaluated with ultrasound, ultrasound-guided biopsy, and/or MRI-guided biopsy. Patient navigators accompanied all women to all appointments, including follow-up care.

Overall, there were seven benign biopsies conducted in the mammography group. One cancer was found, for a detection rate of 12%. Thirty-one benign biopsies were done in the combination group; seven cancers were discovered, for a detection rate of 18%.

Of the cancers that were staged, the MRI had detected one stage 0 tumor, four that were stage I, and one each that were stage II and III. The mammogram detected one tumor that was stage II. So the MRI detected some cancers in an early stage.

For screening alone, the cost per diagnosis was $37,375 for mammography, compared with $27,722 for MRI.

These figures, however, were calculated using a lower MRI rate than many institutions might pay. For the study, the cost of the MRI was negotiated to a reduced rate of $649. Dr. Ford said in an interview that the calculation might change if the MRI rate were more or less.

There also was a very good compliance rate with follow-up studies. Most likely, that is because those services were offered free of charge to participants and because they were constantly interacting with patient navigators, said Dr. Ford.

Six of seven women in the mammography group who were referred for follow-up complied. Twenty-eight of the 31 MRI screening patients returned for follow-up.

The study was supported by the Susan G. Komen for the Cure, the Avon Foundation Breast Care Fund, the Kate B. Reynolds Charitable Trust, and the Breast Cancer Relief Foundation.

WASHINGTON – Magnetic resonance imaging screening for breast cancer is feasible and cost effective for high-risk underserved women, according to a study conducted by Duke University Medical Center researchers.

The investigators, led by Dr. Anne C. Ford, assistant professor of obstetrics and gynecology at the center, wanted to determine whether targeting MRI screening, which has the potential to increase the number of benign biopsies, would increase costs.

The researchers included 299 women who participate in a high-risk clinic at Duke, who were given a digital mammogram followed by an MRI, as well as 299 average-risk women recruited through an outreach program to serve as controls. High risk was defined as a greater than 20% lifetime risk of breast cancer, the investigators reported at a conference sponsored by the American Association for Cancer Research.

The women were racially diverse. The mammography group was 40% African American, 25% white, 25% Hispanic, and 10% other. The MRI group was 62% white, 33% African American, 3% Hispanic, and 2% other.

Women found to have an abnormal mammogram were evaluated by ultrasound, ultrasound-guided biopsy, and/or stereotactic biopsy. Women with an abnormal breast MRI were evaluated with ultrasound, ultrasound-guided biopsy, and/or MRI-guided biopsy. Patient navigators accompanied all women to all appointments, including follow-up care.

Overall, there were seven benign biopsies conducted in the mammography group. One cancer was found, for a detection rate of 12%. Thirty-one benign biopsies were done in the combination group; seven cancers were discovered, for a detection rate of 18%.

Of the cancers that were staged, the MRI had detected one stage 0 tumor, four that were stage I, and one each that were stage II and III. The mammogram detected one tumor that was stage II. So the MRI detected some cancers in an early stage.

For screening alone, the cost per diagnosis was $37,375 for mammography, compared with $27,722 for MRI.

These figures, however, were calculated using a lower MRI rate than many institutions might pay. For the study, the cost of the MRI was negotiated to a reduced rate of $649. Dr. Ford said in an interview that the calculation might change if the MRI rate were more or less.

There also was a very good compliance rate with follow-up studies. Most likely, that is because those services were offered free of charge to participants and because they were constantly interacting with patient navigators, said Dr. Ford.

Six of seven women in the mammography group who were referred for follow-up complied. Twenty-eight of the 31 MRI screening patients returned for follow-up.

The study was supported by the Susan G. Komen for the Cure, the Avon Foundation Breast Care Fund, the Kate B. Reynolds Charitable Trust, and the Breast Cancer Relief Foundation.

WASHINGTON – Magnetic resonance imaging screening for breast cancer is feasible and cost effective for high-risk underserved women, according to a study conducted by Duke University Medical Center researchers.

The investigators, led by Dr. Anne C. Ford, assistant professor of obstetrics and gynecology at the center, wanted to determine whether targeting MRI screening, which has the potential to increase the number of benign biopsies, would increase costs.

The researchers included 299 women who participate in a high-risk clinic at Duke, who were given a digital mammogram followed by an MRI, as well as 299 average-risk women recruited through an outreach program to serve as controls. High risk was defined as a greater than 20% lifetime risk of breast cancer, the investigators reported at a conference sponsored by the American Association for Cancer Research.

The women were racially diverse. The mammography group was 40% African American, 25% white, 25% Hispanic, and 10% other. The MRI group was 62% white, 33% African American, 3% Hispanic, and 2% other.

Women found to have an abnormal mammogram were evaluated by ultrasound, ultrasound-guided biopsy, and/or stereotactic biopsy. Women with an abnormal breast MRI were evaluated with ultrasound, ultrasound-guided biopsy, and/or MRI-guided biopsy. Patient navigators accompanied all women to all appointments, including follow-up care.

Overall, there were seven benign biopsies conducted in the mammography group. One cancer was found, for a detection rate of 12%. Thirty-one benign biopsies were done in the combination group; seven cancers were discovered, for a detection rate of 18%.

Of the cancers that were staged, the MRI had detected one stage 0 tumor, four that were stage I, and one each that were stage II and III. The mammogram detected one tumor that was stage II. So the MRI detected some cancers in an early stage.

For screening alone, the cost per diagnosis was $37,375 for mammography, compared with $27,722 for MRI.

These figures, however, were calculated using a lower MRI rate than many institutions might pay. For the study, the cost of the MRI was negotiated to a reduced rate of $649. Dr. Ford said in an interview that the calculation might change if the MRI rate were more or less.

There also was a very good compliance rate with follow-up studies. Most likely, that is because those services were offered free of charge to participants and because they were constantly interacting with patient navigators, said Dr. Ford.

Six of seven women in the mammography group who were referred for follow-up complied. Twenty-eight of the 31 MRI screening patients returned for follow-up.

The study was supported by the Susan G. Komen for the Cure, the Avon Foundation Breast Care Fund, the Kate B. Reynolds Charitable Trust, and the Breast Cancer Relief Foundation.