Now that the American Cancer Society has recommended that women at high risk of developing breast cancer undergo annual MRIs in addition to yearly mammograms for detection, some local breast cancer specialists worry the costly tests may not be ordered appropriately.

They agree, though, that magnetic resonance imaging scans are an essential complement to mammograms in efforts to detect breast cancer early.

"In breast cancer, MRIs are quite popular and useful. I order them on all of my newly diagnosed breast cancer patients," said Dr. Josette Spotts, a Las Vegas breast surgeon. "Just this week, in my office, I ordered five or six. I usually do them as a diagnosis work-up prior to surgery.''

Spotts said her only concern is that MRIs will be ordered unnecessarily and by someone who doesn't know how to interpret them.

"MRIs give higher false positive results, which could lead to unnecessary biopsies,'' she said. "The most important thing for women is to find a place where they do a lot of MRIs and with radiologists who know how to interpret these tests accurately.''

A breast MRI is a noninvasive procedure that physicians use to get a cross-sectional, three-dimensional view of what the inside of a breast looks like.

For a mammogram, a low-dose X-ray machine creates images of both breasts. Those images can show small lumps or growths that may not be felt during routine breast exams.

The American Cancer Society recommends that MRIs be used when a patient has a certain gene, known as the BRCA, that is linked to breast cancer.

Spotts agrees with the recommendation, but she doesn't believe the procedure should be undergone just because other, less definitive risk factors may be present.

"The BRCA is a proven genetic abnormality that leads to breast cancer. A patient with this gene has a 90 percent chance of having breast cancer in their lifetime. That is a very significant percentage, and obviously screening is going to be beneficial either with MRI or a mammogram,'' she said.

"But for the normal population, or those who have less of a chance of getting breast cancer in their lifetime, MRI screening is certainly not cost-effective."

Unfortunately, Spotts said, whenever something new is mentioned in health care, people tend to latch on quickly.

"I see it so often where a doctor has ordered an MRI on someone who is just having breast pain,'' Spotts said. "Breast pain is a very common complaint. To get an MRI to evaluate breast pain, that is totally worthless, and that is happening here a lot.''

Dr. Mark Laussade, a breast-imaging radiologist at Sunrise Hospital's The Breast Center, made similar comments. His concern is that more MRIs could lead to unnecessary biopsies as well. As with all diagnostic tests, he said, benefits, costs and risks have to be weighed.

Breast cancer is the most frequently diagnosed cancer among women, with an estimated 178,480 new cases of invasive breast cancer expected to occur in the United States this year. Deaths from breast cancer among women are second only to lung cancer deaths.

The benefit of MRIs, specifically for breast cancer detection, is that tumors can be found early. This leads to earlier treatment and better patient outcomes, Laussade said. The downside is that MRIs pick up a lot of subtle abnormalities, because they are highly sensitive.

"They find more things that require biopsies to determine what they are. Though biopsies are very low risk -- there's a very low chance of getting an infection in the blood -- about three-fourths of biopsies don't result in cancer,'' Laussade said.

And though a biopsy can put a patient's mind at ease, he said, they "can cause a lot of anxiety in the interim."

"You undergo the MRI, and then you are told something is there but not what it is. The patient then has to wait for the biopsy results before they know if it is cancer or not.''

For that reason, as well as the cost of an MRI, Laussade said it is crucial that MRI screenings be done only on people who are at relatively high risk.

According to the American Cancer Society's new guidelines, women should get an annual MRI, along with a mammogram if:

• They have a BRCA1 or BRCA2 mutation, genes known to be responsible for breast cancer.

• A parent, sibling or child has the BRCA1 or BRCA2 gene.

• Their lifetime risk of breast cancer has been scored at 20 percent or greater based on one of several risk assessment tools that look at family history and other factors.

• They received radiation to the chest between ages 10 and 30.

• They have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or a family history of the syndromes.

Dr. Mary Ann Allison, a breast oncologist for Comprehensive Cancer Centers of Nevada, who sees patients after they have been diagnosed, said she is pleased the American Cancer Society has finally released the MRI recommendations.

Allison said physicians in Nevada, especially Las Vegas, have been front-runners for MRI use in breast cancer detection.

But she also has concerns that there will be a flood of orders for MRI procedures.

Laussade said the expense of MRIs, between $2,000 and $4,000 each, will be felt beyond the patients who undergo them. Future orders of MRIs could cause insurance premiums to go up as more plans start approving and paying for them, he said.

"I think most (health insurance companies) are getting on board. Three or four years ago, it was almost impossible to get them to pay for it,'' Spotts said. "I think they see how the standard in care is changing and know that they are obligated to cover these tests."

Still, she said, every insurance plan is different. "Some may reimburse and others may not. The good thing is, Medicare recently started covering them. Usually, private insurance providers follow what Medicare does.''