Breast MRI and Early Detection
This editorial by Klijn from JCO is especially timely for me as I had my annual breast MRI yesterday. If you have ever had a breast MRI (or any other MRI), you know that the experience is not exactly comfortable or pleasant--but neither is it horrific. The whole process usually takes almost an hour and involves in IV with contrast, administered half way through the procedure, and lying perfectly still for the duration. People with any problems with small spaces often have psychological trouble with MRIs, but this is less likely with breast exams due to the different equipment. For a breast MRI, you lie on your stomach, and there are quaint holes in the table, placed at just the right spots for your breasts to fall through (WHO thinks of these things?). Therefore, you are unaware of the low ceiling and can look forward and out of the tube. Anyway, blessedly, my exam went fine, and the results were good.
Breast MRIs are part of regular screening and follow up for some women with the BRCA1 or BRCA2 gene mutations and/or a personal history of breast cancer. It has been added to my annual routine since my second breast cancer. Like most people on this schedule, I also have an annual mammogram, doing one exam each six months.
Here is a quote from the editorial and then a link if you want to read more:
Do we have a new standard of care for screening of women with a family history of breast cancer?First of all, the results of this EVA trial contribute to the accumulating evidence that MRI is not only the most important screening modality in gene mutation carriers, but also in women with a familial risk without a documented BRCA1/2 mutation and aCLTRof20%to 50%. Thus, the results support the guidelines of the American Cancer Society.16 However, for several reasons, many radiologists and oncologists think that it is still too early to abandon mammography despite the fact that in the studies of Kuhl et al mammography did not significantly add to the sensitivity and diagnostic accuracy of MRI alone. Firstly, in other large studies the combination of MRIandmammographywas significantly superior to either screening modality alone (Table 1).4 Second, the number of screen-detected DCIS cases across all published studies is still very small. Third, the experience ofMRIis variable among centers participating in trials and certainly outside trials mandating a learning curve.