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Friday, August 22, 2008
Breast cancer? Want to keep your breast? Beware of MRI.
Nothing is as good as MRI in detecting breast cancer. Because of this women who have had their breast cancer detected by the usual means – mammography or feeling a lump – often undergo MRI to see of there is any more cancer in the breast.
MRI (Magnetic Resonance Imaging) is a complicated (and expensive) procedure that depends on the interaction of a very strong magnetized cylinder, radio waves and water molecules in your tissues to produce an image of your body. It has been used extensively and most effectively to examine the brain. However, it is also good at looking at other tissues and in the last few years has been used to look for breast cancer.
At first, MRI was used to screen women with a high likelihood of developing breast cancer (those with the BRCA genetic mutation, for example) because it is so good at picking up cancers. More recently, doctors have ordered MRIs on women who have been diagnosed with breast cancer to see if there is more than one cancer in the breast.
The reason for this is that if a woman wants to have a lumpectomy to treat her cancer, the doctor wants to make sure that there won’t be any cancer left behind in the rest of the breast. Sometimes, the MRI will pick up another lesion. Most surgeons will usually recommend the entire breast be removed in this situation.
But, there is a problem with this. MRIs are so sensitive that they not only spot small cancers, they often find changes in the breast that may look like cancer, but aren’t. Doctors call these call false positives. So it is possible that a woman will have her entire breast removed because the MRI finds something that turns out not to be cancer.
How often does this happen? Lots. A recent survey of all the articles written about MRIs and breast cancer detection found that the MRI is correct only about two-thirds of the time. That means that one-third of women who have a mastectomy because of the MRI findings didn’t need it.
A small price to pay, you say, for the benefit of catching that extra little cancer in the other women. But wait a minute. Before MRI came along, we did just fine with lumpectomies followed by radiation. Only a small percent of women treated this way had a new cancer develop in their breasts. This means that the radiation, which is given to all women who have a lumpectomy likely got rid of the other tiny cancer or cancers.
Is all this MRI testing overkill? Does it save lives? We really don’t know. We do know it costs some women their breasts. This jump to new technology may be a mistake, but someone will need to have the money, time and passion to find out by doing the appropriate studies. Until them, women should ask their doctors whether this extra test is really necessary.
Posted by Herman Kattlove
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