We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

In Defense of Screening for Breast Cancer With Magnetic Resonance Imaging

David L. Keller, MD
JAMA Intern Med. 2014;174(8):1417. doi:10.1001/jamainternmed.2014.810.
Text Size: A A A
Published online


To the Editor Regarding the recent commentary by Hwang and Bedrosian1:

  1. The high prices charged by hospitals for magnetic resonance imaging (MRI) examinations are not intrinsically necessary. The regular cash price for a noncontrast 3 Tesla brain MRI, including all physician and facility charges, is $350 at a local for-profit imaging center.2 The local nonprofit hospitals charge far more for the same examination.

  2. Younger women have a higher content of glandular breast tissue, which is sensitive to the ionizing radiation exposure with mammography. They also have more expected years of lifespan during which to develop radiation-induced breast malignant neoplasms.

  3. Many women are not compliant with screening mammography because of the pain caused by the compression of the breast glandular tissues. Again, younger women are more affected by this pain and have more quality-adjusted life years to lose by not screening. Breast MRI is not painful.

  4. The increased sensitivity of breast MRI, even at the expense of reduced specificity, is compatible with the purpose of a screening examination. When screening for cancer, a false-positive finding can be addressed with further testing, but the harm caused by a false-negative finding often cannot be mitigated. The harms caused by a false-positive cancer screening test finding can be controlled if the informed patient chooses watchful waiting rather than an immediate invasive biopsy.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





August 1, 2014
E. Shelley Hwang, MD, MPH
1Duke University Health Systems, Duke Cancer Institute, Durham, North Carolina
JAMA Intern Med. 2014;174(8):1417-1418. doi:10.1001/jamainternmed.2014.803.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...