https://orcid.org/0000-0002-3613-9472
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Matthew F Covington, Molecular Breast Imaging Deserves Fair and Balanced Consideration, Journal of Breast Imaging, Volume 2, Issue 6, November/December 2020, Page 519, https://doi.org/10.1093/jbi/wbaa073
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I read with interest the recent “From the Editor” written by Dr Harvey (1) discussing the recent article from Dr Hendrick titled “Radiation Doses and Risks in Breast Screening” (2). While I agree with many statements from Dr Harvey and Dr Hendrick, the results of Dr Hendrick’s article may mislead readers, given the one-sided presentation of the risks of each screening modality without discussing the corresponding benefits. Indeed, Walter Huda, PhD, wrote that “it is inappropriate to only compute the total number of cancers in a patient population that undergoes radiologic examinations because these computations ignore the likely enormous collective benefits associated with indicated examinations” (3).
I fear that Dr Hendrick’s results will limit access to molecular breast imaging (MBI) for supplemental screening. I was similarly troubled that Dr Harvey wrote that the “total body dose” of MBI “limits utility.” Most nuclear medicine studies require systemic radiation, yet these are routinely performed given the high net benefit of each exam. The net benefit of MBI for supplemental screening is five to nine times higher than the risk based on prior estimates by Dr Hendrick and myself with Dr Brown (4,5). Surprising to some, MBI could be the safest option for supplemental screening that currently exists given the potential for severe iodinated contrast reactions with contrast-enhanced mammography, the unknown consequences of gadolinium deposition from contrast-enhanced breast MRI, and the precariously low incremental cancer detection rates of both tomosynthesis and ultrasound.
