Early Detection

Two newer landmark papers have now established MRI as an integral breast screening modality.

In 2007, there a review was done by The American Cancer Society with guidelines for breast screening with MRI as an adjunct to mammography (CA Cancer J Clin 2007.). This review article contains the American Cancer Society’s new recommendations for regular monitoring using breast MRI:

  • Gene carriers and their first-degree relatives
  • All patients with a 20% lifetime risk as defined by recognized risk tools, such as those utilized at the Ville Marie Breast Cancer Risk Assessment Clinic
  • Patients with prior chest radiation between ages 20 and 30
  • Certain patients included in the following categories (based on their individual cumulated risk factors):
    • Lifetime risks over 15%
    • Lobular carcinoma in situ
    • Atypical lobular hyperplasia
    • Ductal atypical hyperplasia
    • Heterogeneously dense breasts on mammography
    • Women with a personal history of breast cancer

These recommendations are conditional on an acceptable level of quality of MRI screening, which should be performed by experienced providers in facilities that provide MRI-guided biopsy for the follow-up on any suspicious result.

A Research Study

A 2007 study published in the New England Journal of Medicine titled “MRI Evaluation of the Contralateral breast in women with recently diagnosed breast cancer” discussed the importance of screening.

In this study, MRI detected 30 clinically and mammography occult tumors in the contralateral breast in 969 patients with an established breast cancer. MRI detection was not marred by breast density. Forty percent of the tumors detected by MRI were DCIS and the average size of the invasive tumors, all node negative, was 10.9 mm. Since these tumors are likely to progress and some can eventually metastasize, if untreated, early detection is very important. The authors thus recommend considering an MRI prior to undertaking surgery or neo-adjuvant therapy.

Early Detection is Important

The accompanying editorial suggested that the control of breast cancer for the foreseeable future will depend mostly on early detection, careful diagnostic evaluation and appropriate therapy. The editorial also pointed out that ultrasonography, MRI, and digital mammography will improve the outcome when they are used as a substitute for, or an adjunct to, conventional film mammography for women in whom the latter has not been useful. While supporting MRI, digital mammography has recently been shown to be a more effective imaging tool in younger women. Since conventional film mammography does not identify all breast cancers, newer imaging tools such as MRI and digital mammography can fill this void.

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