Friday, September 12, 2008

MRI After Breast Cancer Diagnosis Increases Mastectomy Rate and Delays Care

A recent study presented at the 2008 American Society of Clinical Oncologists (ASCO) Breast Cancer Symposium questioned the need for breast MRI on patients recently diagnosed with breast cancer. The abstract “the influence of routine pretreatment MRI on time to treatment, mastectomy rate, and positive margins” was headed by Dr. Richard J. Bleicher, a breast cancer surgeon at Fox Chase Cancer Center, and tried to determine if having an MRI would be helpful for breast cancer patients. Increasingly more women seem to be getting them after the diagnosis.
Basically, is using the latest imaging technology helpful? Already, the American Cancer Society recommends that women at high risk of developing breast cancer, those with a family history or personal history of breast biopsy for example, get screening MRI in addition to mammography. Whether MRI can and should be used as a tool before breast surgery was the reason for the research. The study looked at 577 women, who were referred to the breast cancer clinic between July 2004 and December 2006. The average age of a woman in the group was 57 years old. Nearly 23% of the women had MRI. Women who received MRI were younger (52 years old) than those who did not (59 years old).
Researchers found that having a MRI appeared to delay treatment by nearly 25 days after the initial doctor evaluation. Patients who had a MRI were two times more likely to have a mastectomy rather than breast conserving therapy (BCT). Interestingly, the women who received MRI were not considered at high risk for breast cancer (family history of breast cancer or ovarian cancer) or for recurrence based on tumor size, staging, or pathology. It wasn’t clear to researchers why some women received MRI and why others didn’t.
Perhaps MRI was ordered to help surgeons prepare their plan for surgery. An ideal pre-surgical tool would help the surgeons and patients make better decisions prior any surgery so that an operation is only done one time. So, how did MRI do for breast cancer surgery? Having a MRI before breast cancer surgery made no difference in the likelihood another excision would be needed because the biopsy margins weren’t free of tumor and it didn’t decrease the chance that a lumpectomy would be needed to be converted to a mastectomy. In other words, MRI made no difference, even though intuitively you would think it would. After all, isn’t more information better?
The study concludes that, “our findings suggest that MRI should not be a routine part of patient evaluation for BCT. Greater efforts to define the limitations and appropriate use of breast MRI are needed.”
What does this mean for you? MRI for breast cancer surgery planning is not the standard of care, there is currently no evidence that it makes surgical outcomes better than without it, trying to obtain one can delay treatment by 25 days, and it can also increase your chances of having a mastectomy. Understand that the findings should be limited to those patients in their fifties and probably older. It is difficult to say whether the findings are applicable to younger women in their twenties and thirties as MRI has been found to be somewhat helpful in breast cancer screening and could possibly have a role in pre-surgical planning.
As has been demonstrated many times in medicine, don’t fall into the trap of always assuming the latest technology or test is any better than traditional therapies. As this study suggests, newer methods may actually delay care and result in more surgery (mastectomy) than initially intended. Always try to demand treatments and therapies that are evidence-based.
Read more from the abstract.

1 comment: said...

Hello Davis,

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