Study: MRI May Detect More Cases of Recurrent Breast Cancer

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For anyone who has successfully battled cancer, preventing future recurrence of tumors is a top priority. And a new study of breast cancer patients shows that magnetic resonance imaging, or MRI, of the breast, can be an important tool in helping women maintain that vigilance, even if leading cancer organizations do not currently recommend MRI screening for these women.

Dr. Wendy DeMartini of University of Washington Medical Center led a team that analyzed breast cancers among more than 1,000 women. Some of the women had a history of previous breast cancer, while others had not yet been diagnosed but were considered to be at high risk for the disease, since they either possessed the genetic mutations linked to cancer or had a family history of breast cancer. (More on Photos: The Landscape of Cancer Treatment)

The researchers found that MRI in addition to regular mammograms detected twice the number of cancers among women who had already survived cancer than among those who were at high risk.

The findings suggest that current cancer screening recommendations may be missing a portion of breast cancers among women who have survived the disease, says DeMartini. The American Cancer Society currently recommends that healthy women be screened with an X-ray based mammogram each year beginning at age 40 (a government task force in 2009 rolled back its recommendation, advising most women to get mammograms every other year starting at 50). For women who have the BRCA1 or BRCA2 mutations for breast cancer as well as women with a family history of the disease, the Cancer Society recommends adding MRI screening to their annual mammogram in order to detect potentially malignant growths as early as possible. (More on Revisiting the Debate: Mammogram Benefit for Women in Their 40s?)

But the data on screening women who have been previously diagnosed with breast cancer has been less definitive, leaving many survivors and their doctors confused about whether MRI can help them to pick up recurrent growths sooner and possibly lower their risk of dying from breast cancer. “It’s been an open question, and it’s been challenging for women and their physicians to know whether breast cancer survivors should be having breast MRI,” says DeMartini. “We know these women are at elevated risk, but there haven’t been enough studies to document how much they could benefit, and what the rate of false positives would be in this group.”

The current findings should contribute to that database, says DeMartini, and might be the first step toward changing current MRI screening guidelines to include women who have already been diagnosed with breast cancer. Previous studies have looked at cancer detection rates among breast cancer survivors, but this is the first trial to compare cancer rates among survivors and at-risk women currently advised to have MRI screening. (More on Special Report: Advances for Breast Cancer Patients)

The downside to MRI scans, which use magnetic fields rather than X-rays to provide more detailed images of soft tissue than mammograms, is their tendency to render false positive readings, which could lead to unnecessary additional testing and biopsies of breast tissue, not to mention anxiety and mental distress. MRI scans are also more expensive than mammograms, and because breast cancer survivors are not currently among those recommended to receive MRI screening, women would have to pay for these scans out of pocket.

For those reasons, says Dr. Otis Brawley, chief medical officer of the American Cancer Society, “It would be premature to begin using MRI to detect breast cancer in women with a history of breast cancer based on this study. This study and any other data regarding 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.” (More on Breast-Feeding after Breast Cancer Is O.K.)

If that happens, after the current results are repeated and other trials find similar benefits for screening survivors, perhaps, says DeMartini, more women might be spared the complications and poor prognosis of being diagnosed with advanced-stage breast cancer.

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