MRI Detects Early Breast Cancer Cells

Study Shows MRI Screening Has High Detection Rate of Precancerous Cells

(WebMD)  MRI screening has been considered less sensitive than mammography for detecting precancerous cells in the breast which are confined to the milk ducts, but a new study suggests the opposite is true.

Breast MRI detected 92% of surgically confirmed cases of ductal carcinoma in situ (DCIS) in the German study, compared to a 56% detection rate for mammography. Because DCIS often develops into invasive breast cancer, it is almost always treated with surgery to remove all of the DCIS tissue.

The study appears in the Aug. 11 issue of the journal TheLancet.

In the U.S., magnetic resonance imaging (MRI) is currently recommended in addition to an annual mammogram only for very high-risk women. But researcher Christiane K. Kuhl, MD, of the University of Bonn, says the new findings could mean a much broader use for breast MRI screening in the future.

"I would go so far as saying this is the beginning of the death of mammography, but it is going to be a very, very slow death," Kuhl tells WebMD.

"It will take many years before we have enough randomized prospective trials to fully confirm our findings and enough radiologists who are qualified to perform MRI to screen for breast cancer."

The Problems With MRI

Debbie Saslow, PhD, of the American Cancer Society, is unconvinced. She tells WebMD that mammography is, and will remain, the screening tool of choice for breast cancer for at least the next decade.

"We will see more technologies like MRI approved for use along with mammography," she says. "But I don't know anyone who believes that any of these technologies are candidates for replacing mammography."

Availability and cost are presently two important obstacles to a broader use of breast MRI in the U.S., but they are not the only ones, Saslow says.

A breast MRI can cost $1,000 to $1,500 -- ten times the typical cost of mammography. And there are currently not enough radiologists trained in the procedure or dedicated breast MRI machines to provide screening to a larger population of women.

But false positive results remain the biggest impediment to the use of breast MRI in the screening of average-risk women, Saslow says.

The imaging technique is so sensitive that it finds many suspicious growths that turn out not to be breast cancer (false positive), resulting in many unnecessary biopsies.

In the roughly 2% of American women who are considered to be at high risk for breast cancer, the benefits of screening MRI outweigh these risks, but Saslow says this is not true for most other women.

"For average-risk women, the harms of MRI outweigh the risks," she says. "In addition, there have been no studies, including the current one, which assessed MRI screening of women who were not at high risk."

Roughly one in six (29 of 167) of detected DCIS cases in the study by Kuhl and colleagues occurred among average-risk women. The rest, Saslow points out, occurred in women with a known elevated breast cancer risk.

Ninety-three were referred for MRI because of abnormal mammograms, 18 had been treated for breast cancer, and eight had family history of the disease.

"The women in the study were not representative of the population at large, so it doesn't tell us much about the use of MRI in average-risk women," she says.

The Promise of MRI

About 20% of breast cancers now detected are confined to the milk ducts, compared to just 2% prior to the widespread use of mammography.

In an editorial accompanying the German study, radiology professor Carla Boetes, MD, PhD, of Radboud University in The Netherlands, writes that while mammography had dramatically improved the detection of these very early breast cancers, wider use of screening MRI might have an even greater impact.

"That only 20% of tumors detected through screening are pure DCIS is disappointing, when one keeps in minthat most breast tumors probably evolve from DCIS," she writes. "The observation that MRI detects many DCIS lesions that go unnoticed on mammography implies that some invasive carcinomas can be prevented by timely intervention on the basis of MRI findings."

[Netterz]

The one thing that was NOT mentioned in this article at all, is the problems for women with Large breasts with Fibrous breast tissue. MRI has been very positive for women with this issue, like myself. I have breast cancer, am battling it now. Because all women are shelved in one catagory based on how insurance catagorizes us all, and dictates HOW we are treated and when, I find it obsurd. There is NO TYPICAL BREAST CANCER. Instead of allowing the doctor who is in front of the woman, making the decision on what tests are the best for each woman, ins co's determine it for both doctor, and patient. I wasted 6 weeks on tests that didnt need to be done, to get to the ones my doc, and my surgeon knew were needed. MRI was the most needed, since a typical mammogram doesnt work for women with large breasts as well. Insurance reform is a serious issue. ts the reason our health care is out of control. There making billions, while most Americans are going with out what they need. Read up on drive thru radical mastectomies, and other treatments for cancer. Its insane how women are treated in such a scary life altering illness.

[erasmus6]

OldThought

Move to Canada, you will be well taken care of.

[erasmus6]

OldThought

One more thing, if you do move here please leave your guns behind.:)

[tmkgls]

erasmus6: What does Canada have to do with OldThought's comment? I don't see that she is advocating Universal Health Care. She only mentions insurance reform.

6 weeks is a long time to have to wait for a thorough diagnosis. It was time wasted letting the cancer grow when, if the insurance company would've just let the doctor do what he believed best, this woman may have been better off by the cancer being smaller/less in her breasts.

[ilovetodd03]

Regarding MRI for detecting breast cancer:
You should not advocate this as "the preferred study for detecting breast cancer cells", the mammogram is the first study done, and if something is in question or a woman has a pre-exiating breast condition/diagnosis, THEN the MRI is in order. I am a Radiologic Technologist, and I have seen some woman try to book a screening mammogram w/an MRI simply because they have heard that a mammogram is "painful". The way you have reported this article is sure to provoke the same response. Yes, it is more sensitive, but by no means does it replace the mammogram. The MRI is used if a woman has breast implants or if a lesion is seen on a mammogtam. Reputable and ethical Radioigists will not read the study as such, and insurance companies will absolutely not pay for MRI as a screening, just to eliminate "discomfort". In addition, Mammograms are not painful when done by professional
Mammography Technologists. It may simply require a little research to determine where to go for the study, and "word-of-mouth" as well.

[erasmus6]

tmkgls

"Because all woman are shelved in one category based on how insurance catagorizes us all and dictates How we are treated and when..."

"...ins co's determene it for both doctor and patient..." posted by OldThought

Our system doesn't work the same way yours does.
Our healthcare covers all doctor, specialists visits, covers all tests, surgeries etc. The doctor decides what tests you get. If she was here she would have gotten the right test for her needs.