Over the past few years, the number of women whose doctors have suggested that they get an MRI after a breast cancer diagnosis has increased dramatically. But does this mean that these women are getting better, more effective medical care? Probably not, as a study presented at a meeting of the American Society of Clinical Oncology earlier this month revealed.

There is no evidence that having an MRI will improve your chances of surviving your cancer. What it will do, though, is make it more likely that you will have a mastectomy instead of a lumpectomy. Why? Because the super sensitive MRI is finding spots that were not seen on the mammogram.

To most people, this sounds like a good thing. But that’s why when it comes to treating cancer, it’s important to question our assumptions. Those of us who have been in this field for a long time have been reminded of this again and again. In fact, many of us have seen this same situation before.

In the “old” days when we were beginning to study whether lumpectomy followed by radiation would be as effective as mastectomy, several studies were done where a lumpectomy was performed prior to the mastectomy. This allowed researchers to study the tissue that would have been left behind if only a lumpectomy had been performed. These studies found that there were times when specks of cancer would have been left behind after the lumpectomy, and they were used to argue against lumpectomy. But the radiation given after a lumpectomy will take care of those specks. How do we know? Because studies have shown that women who have a lumpectomy followed by radiation have the same survival rates as do women who have a mastectomy. So, the fact that these specks are there isn’t new. It’s just that the use of MRI after mammography has focused our attention on them again. But nothing has really changed. More is not better.

But wait, you’re saying, it’s been all over the news that Christina Applegate’s breast cancer was found because she had an MRI. That may be true, but that’s confusing the issue. This study looked at MRI after a cancer had been found on a mammography. Christina Applegate has been encouraging women to have an MRI to screen for breast cancer. But the fact is, MRI is not a great screening tool for all women. The problem is that MRI all too often results in a false positive result, which leads to unnecessary worry and medical testing. Further, because MRI only spots lesions that have lots of blood vessels, it may miss the slow-growing cancers that have only a small number of blood vessels. For high-risk women like Christina Applegate, who had a BRCA mutation, there may be some advantages to MRI screening. That’s why in March 2007, the American Cancer Society updated its cancer screening recommendations to suggest that all high-risk women receive annual MRI screening in addition to mammography. But for most women, mammography remains the best screening tool.

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6 Responses to MRI—Back in the News

  1. lastesana says:

    I agree that the MRI should not be the only tool that is used to detect breast cancer. I had an MRI after being diagnosed and it showed spot on the other breast that did not show up on the mamogram. Because of the circumstances I did have a biopsy of the spot which thankfully turned out to be negative. We need to use all the tools when diagnosing. Mamograms, ultrasounds and MRI’s.

  2. elaineQW says:

    I agree that the MRI should not be the only tool used to detect breast cancer. However, dense breasts present a problem for mammograms and we must start taking that fact into consideration. Women generally have been given the feeling that if they have their mammograms annually, they are doing all they can. THIS IS NOT TRUE for women with dense breasts. At the least, they should also have ultrasounds. We must change the guidelines. I am among many women who found the cancer through self exam and whose large tumor (9.5cm) could not be seen on a mammogram.

  3. rturizo says:

    I have been getting an annual Breast MRI in addition to Digital Mammo and Ultrasound since losing my sister in 1996 (she’d just turned 37 and I had my second daughter at 28). I think I was one of the first group in NJ to try it out and boy have I seen that test evolve, LOL!

    Anyway, I am grateful for it to be honest with you and now wait six months to follow the MRI with a Mammo and Ultrasound to spread out my “spot checks”. I have never had BC but my breasts are very lumpy and dense. I am an advocate of early detection being a high risk woman’s best defense. I’ve never had a false positive (thank God) but feel that I’ll deal with it if it happens and be glad test/technology found something even it were a false positive.

    I had a question if you have time ….you mentioned survival rates being the same for lumpectomy as they are for mastectomy – what are reoccurrence rates? Are they lower for mastectomy? Wonder what the numbers are? I think that may help women decide one route versus another – in addition to so many other personal, emotional, physical factors of course.

    I ask because I had a scare earlier this year under my arm pit, and was an emotional wreck until I rec’d the all clear. For me, if I am diagnosed with BC I personally would opt for the mastectomy, it works for me because I am married, have my children already, husband won’t miss them as much as he’d miss me  However, the point is that I would be a basket case with a lumpectomy wondering every day, every checkup – not IF it would return but WHEN.

    I understand that every woman is extremely different so in no way do I mean to downplay the statistics or recommendations, it is a very personal decision that has to be made with a great deal of thought and support. However, I was curious about the reoccurrence rates to see if it really would impact THIS woman’s decision that much or make a difference i.e. lumpectomy versus mastectomy. I personally would just as soon put the BC experience behind me as far away from me as possible to be able to live my life without fear (to some degree). I know there is no guarantee that all breast tissue is removed as it goes up to the neck and down/around etc. so there is still SOME risk, but I feel that the risk of reoccurrence may be less. That is why I feel that I can relate to Ms. Applegate’s decisions.

    Had another question on the BRCA 1/BRCA 2 testing I’d gotten to ask for your thoughts but looks like I blogged enough tonight!

    Love what you are doing, can’t wait to see Army Numbers INCREASE and hope we meet the MILLION mark before this time next year – thank you Dr. Love, Avon and Love’s Lady Militia!

  4. Deirdre says:

    Well Susan’s MRI may have followed a cancer dx but mine didn’t! I had normal mamo’s and when the genetic counselor suggested a breast MRI I did get one only to find DCIS. MRI’s ARE the tool of the future if the goal is early diagnosis. Please keep in mind that all of my mamo’s, digital mamo’s sonagrams were all negative (within days of a positive MRI) so I’m sorry but the only reason MRI’s are not used more often is the cost and insurance! When we insist on them the cost will come down and then and only then will insurance start hiring trained MRI techs and doc’. I whole-heartedly disagree with this article and it is not based on scientific back up – I’m very disappointed!

  5. ninicholson says:

    I would also like to know if the reocurrance rate is higher with a lumpectomy than mastectomy. My doctor recommended the lumpectomy and now I worry that I made a mistake. I found out later that an acquaintance had the same scenario as myself and her doctor recommended a double mastectomy. It is hard to know what is the right decision.

  6. cpkoehl says:

    I previously had excision of atypical lobular hyperplasia tissue 8 years ago but thankfully no malignancy and have no family history of cancer. Have had routine mamo’s with no issues until two weeks ago. Started out the same, microcalcifications present, followed by biopsy only today was told I have invasive lobular carcinoma but not sure how extensive. They want me to have a MRI and after reading this am more frightened that I’ll get false positives or be told a mastectomy is best course of action. How else can they determine how widespread the cancer is if there are no lumps or indications in mamo’s? Don’t want to be stupid and not get the MRI but I’m scared after reading this article. Any suggestions?

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