Breast Cancer Detected by MRI More Likely to Be Treated With Mastectomy

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A study found that when breast cancer was diagnosed with an MRI, women were more likely to have a mastectomy rather than lumpectomy followed by radiation therapy. When breast cancer was diagnosed with a mammogram, women were more likely to get a lumpectomy and radiation.

More than 50% of the women in the study who had disease diagnosed by MRI chose mastectomy, while less than 40% of women diagnosed by mammogram chose mastectomy. Research has shown that lumpectomy followed by radiation therapy is as effective as mastectomy for treating early-stage breast cancer.

MRI is a little better than a mammogram at finding very early-stage breast cancer. This is why the American Cancer Society (ACS) recommends using MRI instead of mammograms to screen certain groups of women at high risk for breast cancer. But MRIs do have a higher rate of false positives compared to mammograms. False positives happen when a test identifies an area that looks like cancer, but turns out to be normal. Besides the fear of being diagnosed with breast cancer, a false positive also means more tests (including biopsies) and follow-up doctor visits. The process can be very stressful and upsetting.

Still, MRIs to screen for breast cancer have been increasing in recent years. At the same time, mammography screening has been decreasing. Almost 25% breast cancer screenings were done by MRI in 2006 -- almost double the number of MRI screenings in 2003. It may be that more doctors and women want the most sensitive test to find early-stage breast cancer, even if it means more false positives. The ACS recommendation to use MRI screening in high-risk women, announced in 2007, probably also increased MRI use.

It's not clear why more women are choosing mastectomy over lumpectomy followed by radiation therapy. It's also not clear if more screening MRIs are directly related to more mastectomies.

Several factors could be affecting these trends:

  • More women may be identified as high-risk. These women may want to follow the ACS guidelines and opt for what they see as a more aggressive screening approach -- MRI -- even if they don't meet all the ACS criteria for being high-risk.
  • If diagnosed with breast cancer, these same women may choose mastectomy because they believe it more reliably removes all cancer tissue. These women may not be convinced that radiation therapy after lumpectomy effectively destroys any unseen cancer cells that might be left behind, despite clear research evidence that lumpectomy plus radiation therapy is just as effective as mastectomy for most women.
  • Many women feel that because of advances in breast reconstruction techniques and options there aren't many cosmetic advantages to choosing lumpectomy over mastectomy.

Together, you and your doctor can decide on a breast cancer screening plan that's best for you and your unique situation. Your doctor can help you figure out which screening technique makes the most sense for your breast cancer risk profile. If you've been diagnosed with breast cancer and surgery is part of your treatment plan, make sure that you and your doctor discuss the pros and cons of ALL of your surgery options. Listen to your instincts, but make sure your instincts are shaped by facts and information that pertain to YOU. You also may want to talk to a plastic surgeon about reconstruction before you make a decision about breast cancer surgery. In some cases, reconstruction options are affected by the type of breast cancer surgery chosen. Take the time you need to make the decision that's best for YOU.

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