Breast MRI May Cause Older Women to Choose Mastectomy Over Lumpectomy

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Breast magnetic resonance imaging (MRI) can help doctors identify cancer lesions and other suspicious areas undetectable on a mammogram or ultrasound of the breasts. The test may be ordered in women with newly diagnosed breast cancer prior to surgery in order to help surgeons plan the best approach to surgery. The findings also may influence the treatment plan both before and after surgery.

A new study suggests that older women diagnosed with breast cancer who have a breast MRI before surgery to remove the cancer are more likely to choose mastectomy over lumpectomy.

The study was published in the August 2013 issue of Breast Cancer Research and Treatment. Read the abstract of “Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer.”

The researchers looked at the medical records of 72,461 women age 67 and older who were diagnosed with stage I to stage III breast cancer between 2000 and 2009. The records were in the SEER (Surveillance, Epidemiology, and End Results) database, a large registry of cancer cases from sources throughout the United States maintained by the National Institutes of Health.

The researchers identified all the women who had a breast MRI before breast cancer surgery and then recorded whether the women had a mastectomy or a lumpectomy.

About 10% of the women in the study had breast MRI before surgery.

From 2000 to 2009, use of breast MRI before surgery went up from 0.8% of cases to 25.2% of cases.

Overall, 43.3% of the women had mastectomy and 56.7% of the women had lumpectomy.

Compared to women who didn’t have breast MRI before surgery, women who had breast MRI before surgery were:

  • 20% more likely to have a mastectomy
  • 3 times more likely to be diagnosed with cancer in both breasts and have a double mastectomy; this study adds more evidence to earlier research results showing that breast MRI finds more breast cancer lesions than mammography

Still, the researchers pointed out that women may have chosen mastectomy over lumpectomy for other reasons besides breast MRI results. Women with a higher-than-average risk of recurrence or at high risk of a new, second breast cancer may feel mastectomy is the best treatment to lower that risk. A woman’s reconstruction preferences also may influence whether she has a mastectomy or a lumpectomy.

Use of breast MRI before surgery isn’t routine, and often the test is reserved for women with dense breasts since cancer and other breast abnormalities can be somewhat harder to see on mammogram or ultrasound in these women.

If you’ve recently been diagnosed with breast cancer, make sure you talk to your doctor about all your treatment options. You and your doctor will consider a number of factors when deciding on how to treat the disease, including:

  • the characteristics of the cancer
  • your age
  • any other health problems you have
  • your medical history
  • the results of any genetic testing you may have had
  • your preferences

Together, you and your doctor will come up with a treatment plan that makes the most sense for you and your unique situation.

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