New scans prompt mastectomies for breast patients
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Breast cancer patients who get newer scans called magnetic resonance imaging are more likely to opt for mastectomies, U.S. researchers reported on Thursday.
The patients who get mastectomies are not living any longer than those who get less radical surgery, the researchers said in preliminary results released ahead of a meeting later this month of the American Society of Clinical Oncology.
The findings suggest that MRIs, which are more sensitive than mammograms, are showing abnormalities that worry patients and doctors alike. They are then opting for total removal of the breast instead of having lumpectomies, in which just the tumor and surrounding tissue is removed.
Dr. Matthew Goetz and colleagues at the Mayo Clinic in Rochester, Minnesota, tracked 5,464 women who had surgery for early-stage breast cancer between 1997 and 2006.
In 2003, just 11 percent of patients got MRIs. By 2006, 22 percent did.
And mastectomy rates declined from 45 percent in 1997 to 30 percent in 2003, but then rose back to 43 percent in 2006.
More than half of the patients who got MRIs opted for mastectomy, compared with 38 percent of the patients who did not have MRIs.
"But the mastectomy rate went up for all women, including women who didn't get MRI," Goetz told reporters in a telephone briefing.
"Our data suggests there are additional reasons for the increase in mastectomy rates that we were unable to account for in the study," he added.
Better breast reconstruction techniques may reassure women they will not be disfigured after a mastectomy, he said. In addition, women who find out they have a genetic predisposition to cancer may opt to have a breast removed.
'SOME BIAS'
"It may also be that when women are selected to be referred to MRI that there is some bias in who is referred," said the American Society of Clinical Oncology's Dr. Julie Gralow, of the University of Washington.
They may have more aggressive disease or hard-to-read mammograms, she said. "What would be a real shame is if women are choosing mastectomy based on MRI readings (of lesions) that are not biopsied ... and they are having mastectomies they don't need," she said.
"Some women just choose to maximize their risk reduction by removing more breast tissue. That's not necessarily a wrong choice," Gralow added -- so long as women understand that the additional surgery will not necessarily translate into a longer life, although it may mean less worry about having to be treated for tumors that come back.
Dr. Allen Lichter, Chief Executive Officer of ASCO, said radiation therapy is standard after breast surgery and should remove any small tumors that cannot be cut out.
"Now MRI sees these things we knew were there," Lichter told Reuters in an interview.
"They are saying, 'Oh, my.'" But, Lichter pointed out, radiation gets those lesions anyway.
"This is true for almost every new test that is introduced in medicine," added Dr. Richard Schilsky of the University of Chicago, president-elect of ASCO.
Computed tomography, or CT, scans had a similar pattern when first used to diagnose lung cancer, he said. "Lo and behold, the CT scan showed all these little nodules in the lung -- the vast majority of which were benign," Schilsky said.
Just this week researchers reported that using ultrasound in addition to mammograms helped spot 28 percent more breast tumors, but it resulted in four times as many false alarms.
What breastcancer.org says about this article…
New scans prompt mastectomies for breast patients
The study reviewed here found that when breast cancer was diagnosed with an MRI, women were more likely to have a mastectomy rather than lumpectomy followed by radiation therapy. When breast cancer was diagnosed with a mammogram, women were more likely to get a lumpectomy and radiation.
More than 50% of the women in the study who had disease diagnosed by MRI chose mastectomy, while less than 40% of women diagnosed by mammogram chose mastectomy. Research has shown that lumpectomy followed by radiation therapy is as effective as mastectomy for treating early-stage breast cancer.
MRI is a little better than a mammogram at finding very early-stage breast cancer. This is why the American Cancer Society (ACS) recommends using MRI instead of mammograms to screen certain groups of women at high risk for breast cancer. But MRIs do have a higher rate of false positives compared to mammograms. False positives happen when a test identifies an area that looks like cancer, but turns out to be normal. Besides the fear of being diagnosed with breast cancer, a false positive also means more tests (including biopsies) and follow-up doctor visits. The process can be very stressful and upsetting.
Still, MRIs to screen for breast cancer have been increasing in recent years. At the same time, mammography screening has been decreasing. Almost 25% breast cancer screenings were done by MRI in 2006 -- almost double the number of MRI screenings in 2003. It may be that more doctors and women want the most sensitive test to find early-stage breast cancer, even if it means more false positives. The ACS recommendation to use MRI screening in high-risk women, announced in 2007, probably also increased MRI use.
It's not clear why more women are choosing mastectomy over lumpectomy followed by radiation therapy. It's also not clear if more screening MRIs are directly related to more mastectomies.
Several factors could be affecting these trends:
- More women may be identified as high-risk. These women may want to follow the ACS guidelines and opt for what they see as a more aggressive screening approach -- MRI -- even if they don't meet all the ACS criteria for being high-risk.
- If diagnosed with breast cancer, these same women may choose mastectomy because they believe it more reliably removes all cancer tissue. These women may not be convinced that radiation therapy after lumpectomy effectively destroys any unseen cancer cells that might be left behind, despite clear research evidence that lumpectomy plus radiation therapy is just as effective as mastectomy for most women.
- Many women feel that because of advances in breast reconstruction techniques and options there aren't many cosmetic advantages to choosing lumpectomy over mastectomy.
Together, you and your doctor can decide on a breast cancer screening plan that's best for you and your unique situation. Your doctor can help you figure out which screening technique makes the most sense for your breast cancer risk profile. If you've been diagnosed with breast cancer and surgery is part of your treatment plan, make sure that you and your doctor discuss the pros and cons of ALL of your surgery options. Listen to your instincts, but make sure your instincts are shaped by facts and information that pertain to YOU. You also may want to talk to a plastic surgeon about reconstruction before you make a decision about breast cancer surgery. In some cases, reconstruction options are affected by the type of breast cancer surgery chosen. Take the time you need to make the decision that's best for YOU.