MRI and mammograms as annual checkup post-treatment?


Question from Radha: Do you recommend MRI along with mammograms as part of the annual checkup, for someone who has had triple-negative breast cancer high grade, stage I, who has been through the standard AC plus radiation treatment after lumpectomy? ACS recommends MRI be done in high-risk survivors. Insurance is not likely to agree even if the oncologist agrees to do it. Should one try to insist on MRI as part of the testing?
Answers - George Sledge, M.D. I think the MRI recommendations made by the American Cancer Society (ACS) are reasonable. In essence, the ACS has recommended MRIs for women who are BRCA1 or BRCA2 mutation carriers, or women who have a lifetime risk of breast cancer of 20% or greater. I think certainly for standard screening, I only recommend MRI for such really high-risk women. For a woman who has already had breast cancer, such as the case you describe, there is no striking reason to believe that that would need to be imaged in a different way than the normal breast cancer patient. It is important to recognize that for any woman with an invasive breast cancer, the greatest risk is not the risk of a secondary breast cancer tumor but rather the risk of a distant metastasis of her first breast cancer. So while continuing imaging of the breast is important, that is likely to be determined by whether or not she has had appropriate therapy to prevent a systemic recurrence.
Beth Baughman DuPree, M.D., F.A.C.S. I agree with the ACS recommendation in the BRCA-positive patients and women with a 20% risk. The other subgroup that I will use MRI for screening is the group of women whose breast cancers were undetectable by mammography, whose mammograms didn't reveal the primary tumor. This is typically a group of women whose mammograms reveal very dense fibroglandular tissue that reduces the sensitivity to detecting an ipsilateral [same breast] recurrence or a contralateral [other breast] primary cancer. This is a small subset of patients, but the inability for the mammogram to have detected the first cancer decreases my confidence in the mammogram to be used as that patient's only screening tool.

On Wednesday, July 16, 2008 our Ask-the-Expert Online Conference was called Triple-Negative Breast CancerGeorge Sledge, M.D. and Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about triple-negative breast cancer and its treatment.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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