Breast MRI Each Year?
Posted 12/1/2010
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How are we ever supposed to know what to believe and how best to care for ourselves? Only two weeks ago, I wrote about a study indicating that an annual mammogram is sufficient screening for women post early breast cancer:
http://bidmc.org/YourHealth/BIDMCInteractive/Blogs/LivingwithBreastCancer.aspx?page=2&entry=1154
Now, here is a new study, as reported in Science Blog, from the Radiology meetings in Chicago that suggests that women with a personal history of breast cancer should have both an annual mammogram and an annual breast MRI. The usual routine is to stagger the two appointments so you have a screening test every six months. This is definitely a "talk to your own doctor" situation, but, just to get you thinking, here is a quote about the new study with a link to read more and comments from the Chief Medical Officer of the American Cancer Society who suggests caution when interpreting this report.
NOVEMBER 29, 2010
CHICAGO — Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).
The American Cancer Society (ACS) guidelines currently recommend annual screening with breast MRI in women with a known gene mutation or with a strong family history indicating a lifetime risk of breast cancer greater than 20 percent. However, the guidelines say there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer themselves.
"In our study using breast MRI screening, we actually detected proportionally more cancers in women with a personal history of breast cancer, compared with those women with a genetic mutation or strong family history who are currently recommended to have breast MRI," said Wendy B. DeMartini, M.D., assistant professor in the Department of Radiology at the University of Washington Medical Center and Seattle Cancer Care Alliance in Seattle. "Further, women with a personal history were less likely to be recalled for additional testing and less likely to have a biopsy for a false positive MRI finding.
The link: http://tinyurl.com/237wvqe
And from the American Cancer Society:
Below are comments from Otis W. Brawley, M.D., national chief medical officer for the American Cancer Society:
"The findings of this study are interesting, but it would be premature to begin using MRI to detect breast cancer in women with a history of breast cancer based on this study.
"Getting the right answer to this very important question is critical for the nearly 200,000 women diagnosed with invasive breast cancer every year and for the more than 60,000 women diagnosed each year with DCIS, all of whom would potentially be "eligible" for an MRI every year if this study is validated. This new study is important, but does not represent the type of study that helps us answer the question about the benefits of MRI for those women, such as whether it diagnoses breast cancer earlier than screening mammography and whether that in fact translates into improved outcomes. Those questions can only be answered effectively through prospective, randomized studies in which half a group of women get mammography and the other receives mammography and MRI.
"Until we have more information, we cannot make any definitive recommendation regarding routine annual MRI for women with a past history of breast cancer. The current report notwithstanding, past studies have shown that in large numbers of women MRI has lower specificity, resulting in an increased number of false positives. Given current concerns about mammography, it is important that we establish recommendations for women who have a history of breast cancer using the best research studies.
"As with all such studies, we will examine the information in light of the totality of information available and update our recommendations for the screening of women for breast cancer when appropriate. This study and any other data regarding about the performance of MRI in women with a personal history of breast cancer will be carefully evaluated in our next review to determine whether our recommendations should be broadened to include this group."
For more information, please see: "Can Breast Cancer Be Found Early?" on www.cancer.org.
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