MRI Information

Hi All,

Since we have been discussing MRI vs Mammos, I thought that you guys would like to see this article that I found online. It is very informative..

MRI Breast Cancer Screening for High-Risk Women


A study in the July 29, 2004 issue of the New England Journal of Medicine compared the effectiveness of magnetic resonance imaging (MRI) with mammography for detecting breast cancer in high-risk women. The study findings show that MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer. However, MRI also was more likely to find "suspicious" items that ultimately turned out not to be cancer, resulting in a relatively high rate of false positives.

How was the study done?
The study looked at approximately 1,900 Dutch women who had genetic or familial predispositions to breast cancer. Of these, 358 had a BRCA 1 or 2 mutation. For those who were not mutation carriers, 1,052 were characterized as "high risk," with a cumulative lifetime risk of 30-49% based on the risk tables of Claus, and 499 were "moderate risk," with a cumulative lifetime risk of 15-29%. The mean age of the women enrolled in the study was 40.

Women were monitored with a clinical breast exam every six months, and were given both a mammogram and an MRI once per year. They were followed for an average of 2.9 years.

What were the results?
Fifty-one breast cancers were found during the study: 44 invasive breast cancers, six cases of ductal carcinoma in situ (DCIS), and 1 case of lymphoma. Thirty-two tumors were identified by MRI, including 22 that were missed by mammography. The sensitivity of detecting invasive breast cancer (the proportion of breast cancer detected when breast cancer is present) was 18% for clinical breast exam, 33% for mammography and 80% for MRI. Specificity (the likelihood of the test being normal when cancer is absent) was 98% for clinical breast exam, 95% for mammography and 90% for MRI.

Although MRI detected more breast cancers, it also led to twice as many unnecessary additional examinations as mammography--420 compared to 207. It also led to three times as many unneeded biopsies--24 vs. 7.

What does this study mean for women?
The decision to undergo screening of any kind must be made on an individual level based on a woman's personal preferences, family history and risk factors. Although this study suggests that MRI finds more cancers among high-risk women, the technology has poor specificity. This leads to an increased likelihood of "false positives," which can cause unnecessary anxiety, pain and expense associated with additional testing, such as biopsies.


It is also important to note that most women who get breast cancer do not have BRCA1 or BRCA2 mutations, and some women with confirmed mutations will never get breast cancer. While screening may help some women who have a strong family history and who have a BRCA1 or BRCA2 mutation make health management decisions, the available medical options are of limited value and have risks and side effects to be considered. Unfortunately, detecting small cancer at an early stage does not necessarily lead to improved survival rates.

This study also adds to the evidence that mammography has serious limitations, and ultimately, is not the answer to ending breast cancer. It is vital that women educate themselves about breast cancer screening, including its potential benefits, risks and limitations. We must accept that we do not know how to detect breast cancer truly early, how to prevent or treat this disease effectively, and focus our attention on getting those answers.

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