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Can Breast MRI Help Evaluate Cancer?

Study Weighs the Benefits, Risks of Routine Breast MRIs for Cancer Evaluation
WebMD Health News
Reviewed by Louise Chang, MD

Sept. 8, 2008 -- Routine use of breast MRI (magnetic resonance imaging) scans to help evaluate cancer after diagnosis is not as beneficial as some believed, according to a new study.

"The bottom line is it doesn't help us as much as we thought it did," says Richard J. Bleicher, MD, a surgical oncologist at Fox Chase Cancer Center in Philadelphia and lead author of the study, presented Saturday at the American Society of Clinical Oncology Breast Cancer Symposium in Washington, D.C.

But another expert who reviewed the study abstract for WebMD says the study was small and that the role of breast MRI to evaluate cancer is still evolving.

On one point all sides seem to agree: More research is needed to determine if MRI can improve the outcomes of women with breast cancer.

Breast MRI

Bleicher and his colleagues reviewed the records of 577 breast cancer patients, including 130 who had MRIs before treatment and 447 who did not. The goal was to determine the effect, if any, of getting an MRI on the time to start treatment, the chances of removal of all the cancer, and other outcomes.

"We wanted to ascertain whether routine MRIs [for cancer, not for screenings] are helpful and do they, in fact, assist us in treatment planning," Bleicher tells WebMD.

The role of breast MRI for screening, he says, is clearer. The American Cancer Society, for instance, advises that MRIs be used in combination with mammograms for preventive screenings of certain women at especially high risk of breast cancer.

But the role of the breast MRI to evaluate breast cancer is not as clear, he says.

The thinking among experts, he says, is that MRIs, because they are so sensitive, may allow better visualization of the cancer, so using one when cancer is diagnosed or suspected should help guide treatment decisions.

Breast MRI Study Findings

Among the findings:

  • Breast MRI was associated with a 22-day delay in the start of treatment. "We don't know why," Bleicher says. It could be because of the scheduling of the MRI itself, or perhaps MRI prompts other biopsies." Three weeks should not change a patient's survival chances, he says, but waiting can clearly add to a patient's anxiety.
  • Those who got the breast MRI were nearly twice as likely to have a mastectomy as breast-conserving surgery, even after controlling for size and stage of the tumor. One reason, he says, may be that the MRI, being highly sensitive, picked up something that looked like cancer but turned out not to be -- a false positive.
  • Those who got the breast MRI were slightly more likely to have what surgeons call positive margins, although this finding could have been a chance finding. The goal is negative margins. "The goal is to excise out the tumor so there is a margin of normal tissue around it, reassuring us the cancer has been completely removed," he says.
  • Younger women were more likely than older women to have MRIs, but the use of the MRI did not correlate with other factors such as family history of breast or ovarian cancer.

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