HER2 Support Group Forums - View Single Post - Lancet article: "MRI of little benefit to Most women with breast cancer

Lani · 11-27-2011, 12:37 PM

Overall survival is not thought to be much improved by finding breast cancer earlier as micrometastasis of disseminated tumor cells appears to be a very early phenomenon in breast cancer. One recent study showed it even happens in a certain number of DCISs.

Nevertheless, very few studies are even looking at serial bone marrows, despite the fact that DTCs have been found to be a much more reliable predictor of eventual metastases than CTCs. They just keep saying that patients won't like it--- well patients don't like chemo, but they keep giving it, even in those who statistically are very much more unlikely to receive any benefit (and much more likely to experience a side effect).

They keep waiting for the technology for detecting CTCs to improve. Even so, it might end up that DTCs are still more reliable for predicting metastatic disease than CTCs.

When I ask why more bone marrow testing is not being carried out, the usual answer I get is that patients might not like it. When prodded, those answering often admit it is that the doctors don't like to do it. Oncologists used to be hematologists as well and used to doing bone marrows and good at doing them. Perhaps it is time for them to "farm out" bone marrow testing to those comfortable with it and good at it and let us find out whether we couldn't improve treatment (make sure treatment is working, test if another treatment would be better) by serial testing of bone marrows, until such time as CTC testing improves and is found to be more reliable (IF it ever turns out that is the case)

There is more that we don't know than that we do know about breast cancer and if articles like this on MRIs are grabbed by insurance companies and government decision makers to allow/disallow testing (or avastin treatment) we may never get to the stage where we find the best ways to detect, treat and prevent bc ie, if treatment, testing without proof of efficacy continues.

We must subdivide (find subgroups of bc) in order to conquer, and that involves testing and treating more people than necessary in the early stages.

It has been estimated that over 70% of breast cancer (all comers, not her2+ patients or triple + patients or ER+ her2- patients with a high Ki67) patients treated with chemotherapy do not benefit from it (and can truly suffer). The downsides to performing a few too many MRIs while we learn where they are most useful seem miniscule in comparison.

Off my soapbox now (sorry about that)!

11-27-2011, 12:37 PM	#9
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	Re: Lancet article: "MRI of little benefit to Most women with breast cancer Overall survival is not thought to be much improved by finding breast cancer earlier as micrometastasis of disseminated tumor cells appears to be a very early phenomenon in breast cancer. One recent study showed it even happens in a certain number of DCISs. Nevertheless, very few studies are even looking at serial bone marrows, despite the fact that DTCs have been found to be a much more reliable predictor of eventual metastases than CTCs. They just keep saying that patients won't like it--- well patients don't like chemo, but they keep giving it, even in those who statistically are very much more unlikely to receive any benefit (and much more likely to experience a side effect). They keep waiting for the technology for detecting CTCs to improve. Even so, it might end up that DTCs are still more reliable for predicting metastatic disease than CTCs. When I ask why more bone marrow testing is not being carried out, the usual answer I get is that patients might not like it. When prodded, those answering often admit it is that the doctors don't like to do it. Oncologists used to be hematologists as well and used to doing bone marrows and good at doing them. Perhaps it is time for them to "farm out" bone marrow testing to those comfortable with it and good at it and let us find out whether we couldn't improve treatment (make sure treatment is working, test if another treatment would be better) by serial testing of bone marrows, until such time as CTC testing improves and is found to be more reliable (IF it ever turns out that is the case) There is more that we don't know than that we do know about breast cancer and if articles like this on MRIs are grabbed by insurance companies and government decision makers to allow/disallow testing (or avastin treatment) we may never get to the stage where we find the best ways to detect, treat and prevent bc ie, if treatment, testing without proof of efficacy continues. We must subdivide (find subgroups of bc) in order to conquer, and that involves testing and treating more people than necessary in the early stages. It has been estimated that over 70% of breast cancer (all comers, not her2+ patients or triple + patients or ER+ her2- patients with a high Ki67) patients treated with chemotherapy do not benefit from it (and can truly suffer). The downsides to performing a few too many MRIs while we learn where they are most useful seem miniscule in comparison. Off my soapbox now (sorry about that)!