Better screening for recurrence?
Meet the Experts
Cecilia M. Brennecke, M.D. is a radiologist and medical director at Johns Hopkins at Greenspring in Baltimore, Maryland. As a breast imaging specialist, she interprets mammography, performs ultrasound and breast MRI, conducts clinical breast exams, and performs the newest image-guided biopsy procedures.
Marisa Weiss, M.D. is an oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
Question from tracey: I was diagnosed with breast cancer last year at age 41. I've finished eight cycles of chemotherapy and almost eight weeks of radiation. The problem is that I have no confidence in the ability of mammograms or physical exams to catch a recurrence. Is there a better screening method? Would I be safer having an annual MRI or PET scan?
- Answers —Cecilia Brennecke, M.D.: In the early days of mammography, there was some discussion among physicians that the X-ray dose was possibly going to cause more cancer than was diagnosed. That was actually disproved, but it was quite controversial for a time. It even led to a recommendation that a screening mammogram be just one view of each breast because of the perceived fear of the radiation. There's actually been no evidence that breast cancer has been caused by imaging, and the dose has decreased since the beginning.
For this particular woman, I would advise her to continue to have a mammogram, a clinical breast exam, and ultrasound if needed for screening for breast cancer. These are still the most reliable tools that we have for detecting early cancer and recurrence. MRI at this point is a secondary tool. We don't have any evidence of its efficacy over time or how often it should be used. PET scanning is for the entire body rather than just the breast. PET can be used to check for metastatic disease, but not as a routine tool.
- Marisa Weiss,, M.D., president and founder: In addition, PET scanning is not very good at finding small cancers, for example under 1 cm.
- Cecilia Brennecke, M.D.: It wouldn't be used for non-invasive disease.
- Marisa Weiss,, M.D., president and founder: You may find that doctors in different institutions and in different parts of the world have different opinions and different styles of practicing medicine. For example, at Memorial Sloan-Kettering in New York, they are integrating MRI scanning into the follow-up of women who've had breast cancer personally, as well as in women who've not had breast cancer, but who are at high risk because of a known inherited gene abnormality. Until the role of MRI scans is better understood, it's hard to come up with strong recommendations one way or the other. It is a very useful tool under a number of different clinical circumstances. These tests in combination are likely to give you the best information.
It's also important for the test results of each of these studies to be correlated with the other studies. For example, you are likely to learn much more about the health of your breast if your radiologist is looking at both your ultrasound and your mammogram and combining the information. If you have each of these tests in two different institutions, it's possible you may not capture the full amount of information available.
- Cecilia Brennecke, M.D.: The other thing that brings up is cases where a woman who has a mammogram at one facility, then changes facilities and doesn't recognize the importance of bringing past films to the new facility. We're looking for the most subtle change, and if we don't have the pre-existing mammogram, we can't look for change. You tie the hands of the person reading the film if you consider each film as a new start. That's something that is extremely common—women going from one site to another and not making it their responsibility to bring the films along with them.
- Marisa Weiss,, M.D., president and founder: You need to bring your films or studies with you wherever and whenever you go to a new place. Bringing the written reports alone is not enough.
On Wednesday, July 16, 2003, our Ask-the-Expert Online Conference was called Breast Cancer Screening. Cecilia M. Brennecke, M.D. and Marisa Weiss, M.D. answered your questions about mammograms, ultrasound, MRI, breast self exams, physical exams by a doctor, and other topics related to breast cancer screening.
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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