- Question from Wondering: For those with a previous breast cancer, are breast MRIs the new standard as a supplement to mammograms, and how often are MRIs recommended?
- Answers - Cecilia M. Brennecke, M.D. MRI is a new technology for the breast and I don't feel that we've sorted out the exact use yet. Right now the accepted use of MRI is in the newly diagnosed woman, to check that breast for a second known site of a breast cancer on the same side, and to check the opposite breast for an unknown site of possible cancer. The use of MRI to screen breast cancer survivors is not yet accepted. It is a very expensive tool. It is difficult to interpret; there is a high rate of false positives—seeming abnormalities that show up on the exams and are not real abnormalities—like a false alarm.
- Marisa Weiss, M.D. At the recent ASCO (American Society of Clinical Oncology) meeting, a very interesting report was presented on the role of MRI scans in women without a personal history of breast cancer but who were known to have a breast cancer gene abnormality. In this study, researchers compared MRI scanning to mammography and ultrasound, and in this high risk population, MRI scans seemed to be able to find small, invasive breast cancers earlier than mammography and ultrasound. Mammography seemed to be better at finding non-invasive (DCIS) breast cancers. There were nearly 2000 women in this study. This information is promising but still early.
- Cecilia M. Brennecke, M.D. I deal with MRI and I don't think we've sorted out exactly where it's going to fit in.
- Marisa Weiss, M.D. In my breast cancer practice, I may choose to use an MRI scan of a woman who's had a breast cancer, if she has a difficult physical exam and a very dense mammogram, or one that's tricky to read. Of course, you need to individualize your care with your doctor. If you choose to have an MRI scan, it is important to go to a facility that specializes in MRI scanning of the breast in order to minimize the chance of a false alarm, and to maximize the chance of learning something useful from the study that will help your doctor take good care of you.
- Cecilia M. Brennecke, M.D. All the centers that perform mammography are accredited. They must pass a stringent set of tests that are performed by the FDA (Food and Drug Administration). But we don't have that oversight for MRI. In general, I would not use an open MRI for breast. You may want to try to find one that is associated with a breast center or a teaching hospital.
- Marisa Weiss, M.D. At some of the universities in Philadelphia, there are actually clinical trials available in which they are following women with MRI, mammography and ultrasound. Participating in such a trial would be a good opportunity to take advantage of this test as well as to advance our knowledge about this important question.
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.
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