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Adding MRI or Ultrasound to Mammograms Improves Detection of New Cancers After Lumpectomy for Younger Women

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A study suggests that adding MRI or ultrasound screening to annual mammogram screening found more new cancers in women who had been diagnosed with breast cancer and had lumpectomy and radiation to treat it.

The research was published online on June 22, 2017 by the journal JAMA Oncology. Read the abstract of “Breast Cancer Screening With Mammography Plus Ultrasonography or Magnetic Resonance Imaging in Women 50 Years or Younger at Diagnosis and Treated with Breast Conservation Therapy.”

Lumpectomy (also called breast-conserving surgery) followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk is about the same with either type of surgery. A woman who has lumpectomy and radiation therapy also may have chemotherapy and hormonal therapy. These treatments are given after lumpectomy to lower the risk of the cancer coming back (recurrence). Still, breast cancer recurrence does happen.

It’s also important to know that the risk of developing a new, second breast cancer in the same or opposite breast is much higher than average after being diagnosed with breast cancer. About 10% to 20% of women who have lumpectomy to remove early-stage breast cancer will have a recurrence of that cancer or develop a new, second breast cancer.

Doctors often recommend an aggressive screening plan after lumpectomy to make sure that any new or recurring breast cancer is found early, when it's most treatable. This might mean having mammograms more often than once per year, which is the recommendation for women who haven’t been diagnosed and are age 40 or older with an average risk of breast cancer. It also might mean having other screening tests along with mammograms.

In this study, the researchers wanted to know if adding MRI or ultrasound screening to annual mammograms would improve detection of any new cancer in women who had been treated with lumpectomy.

The study included 754 women age 50 or younger when they were diagnosed with breast cancer. All the women were treated with lumpectomy.

For each of the 3 years of the study, each woman had an annual mammogram, breast ultrasound, and breast MRI on both the breast that had had lumpectomy and the opposite breast.

During the study, 17 breast cancers were diagnosed. Of the 17 cancers, 13 were stage 0 or stage 1.

Adding either MRI or ultrasound to mammography detected more cancers than mammography alone, with MRI and mammography detecting the most cancers:

  • Mammography alone detected 4.4 cancers per 1,000 women screened.
  • Ultrasound plus mammography detected 6.8 cancers per 1,000 women screened.
  • MRI plus mammography detected 8.2 cancers per 1,000 women screened.

These results suggest that adding MRI or ultrasound to annual mammograms might make sense for women who’ve been treated with lumpectomy for breast cancer.

Still, this study does have some limitations. There was no group of women who only had mammograms for detection comparison. Also, the study didn’t consider the cost of MRI or ultrasound and whether it would be covered by insurance. Finally, while these results suggest that cancers found by mammograms plus ultrasound or MRI after lumpectomy may have a better prognosis than cancers found by mammograms alone after lumpectomy, the study only looked at the characteristics of the cancers at diagnosis, not the treatment outcomes. So, we don't know if women who had mammography plus ultrasound or MRI after lumpectomy had better survival compared to women who had mammography alone after lumpectomy. More research, including looking at treatment outcomes, is needed before we know for sure that adding ultrasound or MRI to mammograms after lumpectomy should be the standard.

If you've been diagnosed with early-stage breast cancer and are having lumpectomy, you and your doctor likely will develop a screening plan that's more aggressive than average to find any cancer recurrence or a new, second breast cancer. Your plan may include frequent exams by your doctor, breast self-exams, mammograms, or other imaging tests, such as ultrasound and MRI. Sticking with your screening plan is just as important as making the plan. After your treatment is done, you may be tempted to skip some follow-up screening tests. Don't -- there's only one of you, and you and your future deserve the best care possible.

It's also important to do all you can to lower your risk of recurrence or a new, second breast cancer. Visit the Lowering Risk for People with a Personal History page to learn more.

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