Diagnostic Imaging
Breast Magnetic Resonance Imaging (MRI) Questions and Answers
Australian Government funding has been provided from 1 February 2009 for Medicare rebates for breast Magnetic Resonance Imaging (MRI) scans of women less than 50 years of age, with no signs or symptoms of breast cancer, but who are at high risk of breast cancer.
This document provides answers to possible questions about the Medicare rebate for breast MRI scans.
1. How did this rebate come about?
In order for an MRI service to receive a Medicare rebate, the scan must be an MRI service listed on the Medicare Benefits Schedule (MBS).
In order for a new service to be listed on the MBS, an application must be made to the Medical Services Advisory Committee (MSAC) for assessment. MSAC is an independent scientific committee which provides advice to the Minister for Health and Ageing on the strength of new evidence relating to the safety, clinical effectiveness and cost effectiveness to Government of new medical technologies and procedures. A rigorous assessment of evidence is thus the basis of decision making when funding is sought under Medicare.
The purpose of this process is to ensure that Australians have access to medical services that are of demonstrated value in terms of safety and effectiveness, and that those services represent value for money to Australians, both as patients and taxpayers.
2. What did MSAC consider?
Following an application to MSAC for assessment, the primary review question considered by MSAC was “what is the safety, effectiveness and cost-effectiveness (to Government) of annual breast MRI in addition to annual mammography with or without breast ultrasound for screening asymptomatic high-risk women under the age of 50 years?” (page vii of the MSAC assessment report-1098).
You can view the MSAC assessment report at MSAC’s website.
3. What was the outcome of the MSAC assessment?
MSAC recommended that:
“Breast MRI, when combined with mammography, is safe and effective in the diagnosis of breast cancer in
asymptomatic women at high risk, when used as part of an organised surveillance program;
Evidence suggests that breast MRI in combination with mammography may be cost-effective (to Government)
when compared with mammography alone in high risk women aged less than 50 years;
MSAC recommends interim public funding for breast MRI in the diagnosis of breast cancer in asymptomatic women with a high risk of developing breast cancer when used as part of an organised surveillance program;
Evidence should be reviewed in not less than 3 years”. (page 79 of the MSAC assessment report)
4. Who is eligible for a Medicare rebate for these items?
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Women less than 50 years of age, with no signs or symptoms of breast cancer, but who are at high risk of breast cancer based on the criteria outlined under question 5 below, are eligible for a Medicare rebate for annual breast MRI scans.
5. How do I know if I am at high risk?
If there is history of breast cancer in your close relatives, you may have increased risk of developing breast cancer. Please discuss your family history with your general practitioner or specialist medical practitioner.
For this new Medicare rebate, women at high risk have been defined as having one of the following:
(a) Three or more first or second degree relatives, on the same side of the family, who have
been diagnosed with breast or ovarian cancer;
(b) Two or more first or second degree relatives, on the same side of the family, who have
been diagnosed with breast or ovarian cancer, if any of the following applies to at least one of the relatives:
- has been diagnosed with bilateral cancer;
- had onset of breast cancer before 40 years of age;
- had onset of ovarian cancer before 50 years of age;
- has been diagnosed with breast and ovarian cancer, at the same time or at different times;
- has Ashkenazi Jewish ancestry;
- is a male relative who has been diagnosed with breast cancer;
(d) Genetic testing has identified the presence of a high risk breast cancer gene mutation.
These requirements were based on the National Breast and Ovarian Cancer Centre’s (NBOCC) clinical practice
guidelines on familial aspects of breast and ovarian cancer (2006).
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6. Who are my first and second degree relatives?
First degree relatives are blood relatives from your immediate family, such as your parents, siblings and children. Second degree relatives are blood relatives from your extended family, such as your aunts, uncles, nieces, nephews, and grandparents from both sides of your parents’ families.
7. Why have the items been restricted to women less than 50 years of age?
Existing evidence shows that a mammogram performs less well in women under 50 years of age due to the density of their breast tissue and an MRI scan may produce better results. Mammograms have proven to perform well for women from 50 years of age whose breast density has reduced with age.
8. Is there a minimum age for eligibility for these items?
There is no minimum age in order to be eligible for Medicare rebates for these breast MRI scan items. The necessity for MRI scans in all circumstances should be determined on a case by case basis with your medical
practitioner.
9. Do I still need a mammogram?
For women of all ages who are at high risk of developing breast cancer, an individual surveillance program should be developed in consultation with your medical practitioner. This may include whether you should have a mammogram or any other additional tests. You should discuss the options available and associated costs with your medical practitioner.
10. If I am less than 50 years of age, and have had a diagnosis of breast cancer, am I eligible for a Medicare rebate for an MRI scan of the breast?
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While MRI may be used in other situations associated with breast cancer, the MSAC application and assessment were focused on “screening asymptomatic high-risk women under the age of 50 years” (page vii of the MSAC assessment report). Therefore the new Medicare rebates are available to these women only.
The Government currently provides Medicare rebates for a range of services for women of all ages with a history of breast cancer such as diagnostic mammograms, ultrasound and guided biopsies.
The role of MRI in the follow-up of women with breast cancer is evolving. At this stage, published guidelines such as those produced by the National Health and Medical Research Council recommend that the follow-up of breast cancer include regular clinical examination and annual mammograms.
11. What does the breast MRI scan involve?
MRI uses strong magnetic fields to generate images that can help diagnose illnesses. It is especially effective on soft tissue. Unlike some other diagnostic imaging tools such as X-rays and Computed Tomography (CT) scans, MRI does not use ionising radiation.
A breast MRI scan is performed using an MRI machine fitted with a dedicated breast coil. If you want to know more about what is involved, discuss this with your MRI provider prior to undergoing your MRI scan.
12. Who can request and perform the breast MRI scan?
To be eligible for a Medicare rebate, breast MRI scans must be requested by your specialist medical practitioner. All Medicare-eligible MRI scans, not just breast MRI scans, must be request by a specialist medical practitioner.
The involvement of your specialist medical practitioner is important because the ongoing management of young women at high risk of developing breast cancer is complex, and involves counselling, physical examination and the correlation of imaging results from a mammogram, ultrasound and MRI.
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To be able to claim the rebate your breast MRI scan must be performed under the professional supervision of a Medicare-eligible provider on a Medicare-eligible MRI unit.
A “Medicare-eligible provider” is a specialist in diagnostic radiology who is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
13. How can I find a Medicare-eligible MRI unit?
A list of current Medicare-eligible MRI units is available on the Department of Health and Ageing’s website. Alternatively you can call the Department on (02) 6289 1440 and we will post a copy of the list to you.
Medicare-eligible scans conducted on these MRI units attract a Medicare rebate.
14. What will I be charged for the breast MRI scan?
In the MBS, the schedule fee for a breast MRI scan is $690.00.
However, medical practitioners are free to set their own fees for their services which can be above or below the MBS schedule fee. You should discuss the costs for any services and the likely Medicare rebate with your medical practitioners, including the MRI provider, prior to undergoing your MRI scan.
15. Is breast MRI safe?
Breast MRI is a safe procedure and unlike some other diagnostic imaging tools, MRI does not use ionising radiation.
Certain metallic implants, notably some cardiac pacemakers, intracranial aneurysm clips, breast tissue expanders and cochlear implants can put patients at risk from the high magnetic fields associated with MRI. Patients with such implants should not have an MRI scan. The MRI provider will ask you about these issues before your MRI scan.
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16. How many breast MRI scans can I have?
Eligible women can receive the Medicare rebate for a breast MRI scan once in any 12 month period.
If you are concerned about family history as a risk factor for breast cancer, you should discuss this with your doctor.