WASHINGTON (Reuters) - Women with cancer in one breast should get an MRI scan of the other breast to make sure the cancer is not there, too, the American Cancer Society recommended on Wednesday.
Healthy women at high risk of getting breast cancer also should get magnetic resonance imaging scans, the society said.
The recommendations follow a study that shows MRI scans can detect cancer in the opposite breast 90 percent of the time. MRI found breast tumors missed by mammograms, a specialized type of X-ray.
The study, published in The New England Journal of Medicine, involved 1,000 women with cancer in one breast. The MRI scans found 30 out of 33 tumors in the other breast among the women.
"One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast. Having a better technique to find these cancers as early as possible will increase the chances of successful treatment," said NIH Director Dr. Elias Zerhouni.
The National Cancer Institute, one of the National Institutes of Health, paid for the study.
"This study gives us a clearer indication that if an MRI of the opposite breast is negative, women diagnosed with cancer in only one breast can more confidently opt against having a double, or bilateral, mastectomy," added National Cancer Institute Director Dr. John Niederhuber.
Constantine Gatsonis and colleagues at Brown University in Rhode Island said the study was not designed to find out if MRIs or mammograms are better at finding breast cancer among women who have only an average risk.
"It was designed only to see if MRI improved detection of cancers in the other breasts of women already diagnosed with unilateral breast cancer," she said in a statement.
MAKING SURE
The American Cancer Society said women with a genetic mutation that puts them at high risk of breast cancer, called a BRCA mutation, should also have an MRI scan in addition to annual mammograms.
In addition, women with a close relative with such a mutation should get an MRI, the group recommended.
And women who got radiation treatment to the chest between the ages of 10 and 30, such as for Hodgkin's disease, a lymph cancer, should have MRIs.
Such treatment in the 1970s and 1980s has been shown to raise the risk of breast cancer in later life.
"As with other cancer screening tests, MRI is not perfect and in fact leads to many more false positive results than mammography," noted Dr. Christy Russell of the University of Southern California/Norris Cancer Hospital Lee Breast Center, and chair of the American Cancer Society's Breast Cancer Advisory Group.
"Those false positives, which can lead to a high number of avoidable biopsies, can create fear, anxiety, and adverse health effects, making it imperative to carefully select those women who should be screened using this technology."
Breast cancer will be diagnosed in more than 200,000 U.S. women this year and will kill 40,000, according to the American Cancer Society.
American women know the value of breast cancer early detection from the 25-year-old breast cancer awareness movement. The three major breast cancer screening messages have been told loudly and clearly:
But no test or combination of tests is perfect. Even with these three tools, some breast cancers escape detection. Research has shown that between 10% and 15% of breast cancers can be missed even when all three tests are done. Until the breast cancer cure arrives, we need more tools to help detect all breast cancers as early as possible when they are most treatable. Also, women diagnosed with breast cancer in one breast have a higher risk of developing another cancer in the same or the opposite breast. A better approach to detecting a new or existing cancer is hugely important for these women.
The study reviewed here looked at how well breast MRI (magnetic resonance imaging) could detect cancers in the other breast of women just diagnosed with breast cancer. MRI uses magnetic fields to highlight different kinds of tissues, both normal and abnormal. In almost 1,000 women diagnosed with cancer in one breast, an MRI scan was able to detect breast cancer in the other breast of 3% of the women (30 out of 969) that was missed by mammography and clinical examination.
Based on the results of this and another study, the American Cancer Society (ACS) now recommends that women diagnosed with cancer in one breast have an MRI scan of the other breast to make sure there is no cancer there. The ACS also recommends an annual MRI scan for women who are at high risk for breast cancer because they have:
When breast cancer is diagnosed, it's important to carefully evaluate both breasts. You and your doctor may understandably focus only on the breast with the cancer. But knowing what's happening in both breasts (and in your whole body) will help you and your doctors determine the best treatment strategy to get rid of the cancer. Early detection also may help you avoid some treatments that you might otherwise need with a later diagnosis.
It's important to know that MRI is a very sensitive test that can lead to many false alarms. Of the 121 women in this study whose MRI scan showed an abnormality, 30 had cancer; about 25%. That means that about 75% of the women had an MRI abnormality that WASN'T cancer.
The bottom line is that if you've been diagnosed with breast cancer or are at high risk for having breast cancer, an MRI scan is an important additional tool to carefully evaluate both breasts. Information from an MRI scan may help detect breast cancer earlier in high-risk women and may be important in determining the best treatment plan for women already diagnosed with breast cancer. Still, MRI doesn't replace a breast exam by your doctor and mammography. These techniques are important front-line tools for all women.
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