Old-fashioned mammography remains the most practical and best tool for the majority of women, experts say.

Radiologists' phones started ringing like mad in March when the American Cancer Society recommended annual MRIs for women considered at highest risk for breast cancer. And OB-GYNs have found themselves sitting in exam rooms with women who want to know if they should have one and if not, why not?

"Unfortunately, the message that seems to have gotten to many women is: 'You should not get a mammogram; you should get an MRI,' " said Dr. Daniel White, a radiologist and director of breast MRI for Mount Carmel hospitals.

While most doctors laud the tool under the right circumstances, some worry that too many women are being prescribed an MRI. And they stress that even when an MRI is warranted, it doesn't replace the annual mammogram, which is better at picking up cancers that do not spread to adjacent tissue or organs.

With an MRI, doctors look at breast tissue by injecting dye and taking pictures generated by magnetic fields. A mammogram -- an X-ray of the breast -- is not as sensitive as an MRI, particularly in women with dense breasts.

One downside of uncalled-for MRIs is expense. They cost in the $2,000 range, about 10 times what a mammogram does.

Perhaps more important to many women are the emotional and physical costs of biopsies that reveal no cancer.

Screening of any sort is tricky business. It doesn't find just cancers. It also finds things that could be cancer but aren't. These so-called "false-positive" results are more common with MRIs than in mammography.

The rate is about 4 percent to 5 percent for mammography and 11 percent for an MRI, said Dr. Adele Lipari, director of mammography at Ohio State University Medical Center.

Furthermore, there's no research supporting routine MRI screenings and nothing to show that MRIs extend a woman's life expectancy.

Women considered candidates for an MRI include those whose lifetime risk of getting breast cancer is 20 percent or higher. That is based on such factors as genetic predisposition and close relatives who've had the disease. Other candidates include women who had chest radiation for cancer when they were younger and those with some rare medical conditions.

The cancer society's reasoning for recommending MRIs for these women is that the potential benefits in that group outweigh the downsides.

Lipari said the number of breast MRIs she performs has doubled, from about 50 or 60 a week to 100. The women who've come to her have been good candidates for an MRI, she said.

She and other breast-health experts say women who undergo breast MRIs should seek radiologists who specialize in that area because the technique is particularly demanding.

White advises asking a radiologist these questions:

• Do you do dynamic imaging (multiple sequential pictures, not just one)? He thinks that radiologists should.

• How many cases have you done? He has done a few thousand and tracked every one.

• When you say something is cancer, how often is it cancer? White thinks that percentage, called specificity, should be in the high 80s.

Anna Cluxton, co-founder of the local Young Survival Coalition and a member of the group's national board, is concerned that MRIs will be overprescribed in the absence of research to back widespread screening.

While the cancer society's recommendation applies to only about 5 percent to 10 percent of women, Cluxton said doctors might be willing to comply with patient requests.

"Are they going to explain to the patient, 'Yes, your mother had breast cancer at 67 and that doesn't mean that you are at high risk,' or are they just going to write the prescription?" she said.

"I absolutely think there's a place for it, for those women who meet very, very strict criteria."

Cluxton's breast cancer was diagnosed six years ago, at age 32, and she has had an MRI to screen for problems in her other breast.

Dr. Brenda Sickle-Santanello, a surgical oncologist at Grant Medical Center and leader of the hospital's breast-health program, said MRIs have become an important tool particularly in women who already have been diagnosed with cancer. They are better at picking up another tumor and can help doctors get a more accurate picture of a tumor, which helps guide treatment.

As for screening, "It's great if it's applied well, but I'm a little concerned that currently it's being a little over-utilized for not the right indications."

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Invasive breast cancer rates have fallen since the substantial decline in postmenopausal hormone replacement therapy (HRT) occurred, even after a decline in breast cancer screening rates, according to findings published in the 5th Journal of the National Cancer Institute.

"It's encouraging that breast cancer rates decreased with decreases in use of hormone therapy," Dr. Karla Kerlikowske told Reuters Health. This implies that women who stopped using hormone therapy in a relatively short period of time have a risk of breast cancer similar to women who have never used hormone therapy."

Kerlikowske from San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, and colleagues examined whether parallel declines in postmenopausal HRT use and rates of breast cancer are present among women undergoing routine screening mammography.

They point out that the breast cancer detection rate is higher in women undergoing mammography, so "the proportion of women in the population undergoing routine screening mammography will influence population-based estimates of breast cancer incidence."

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From the New York Times:

The young woman in the American Cancer Society advertisement holds up a photograph of a smiling blonde. “My sister accidentally killed herself. She died of skin cancer,” reads the headline.

The public service announcement, financed by the sunscreen maker Neutrogena, is running in 15 women’s magazines this summer. It warns readers that “left unchecked, skin cancer can be fatal,” and urges them to “use sunscreen, cover up and watch for skin changes.”

The woman in the picture is a model, not a skin cancer victim. And the advertisement’s implicit message — that those who die of skin cancer have themselves to blame — has provoked a sharp response from some public-health doctors, who say the evidence simply does not support it.

As the advertisement says, skin cancer is the most common form of cancer. But most skin cancer is not life-threatening: it represents less than 2 percent of all cancer deaths, an estimated 10,850 people this year. Almost all of those deaths are from melanoma, which makes up only 6 percent of all skin-cancer cases.

And the link between melanoma and sun exposure is not straightforward. Dr. Marianne Berwick, an epidemiologist at the University of New Mexico who studies skin cancer, led a study published in The Journal of the National Cancer Institute in 2005 finding that people who had a lot of sun exposure up to the time they got a diagnosis of melanoma actually had better survival rates than those who had little sun exposure. The researchers are conducting a large-scale follow-up aimed at clarifying the relationship between sun exposure and melanoma.

Until that is made clear, many doctors say, it is premature to suggest that people are endangering their lives by failing to use sunscreen.

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