MRIs show breast cancer in the OTHER breast of 3% of newlydiagnosed brst ca patients

[Lani]

from the Wall St. Journal:
MRIs Aid in Spotting
Some Breast Cancer
By ROBERT TOMSHO
March 28, 2007
Magnetic resonance imaging, or MRI, can spot otherwise overlooked cancer in the second breast of women who have already been diagnosed with single-breast cancer, according to a new study.

The findings add to a growing body of research suggesting that MRIs can be a powerful tool for breast-cancer screening and help patients get earlier and more precise treatments for all the sites where cancer might be located.

They also come as MRIs -- which can cost as much as $2,000, or roughly 10 times the amount of a typical mammogram -- have become one of the fastest growing costs in health care, prompting insurers to reduce reimbursement for them and try to limit their use.

The study, which appears in this week's New England Journal of Medicine, followed 969 women receiving breast-cancer treatment at 25 different facilities around the country. All had received a normal mammogram for their second breast before undergoing MRIs, which detected cancer in the other breast of about 3% of the participants.

"We are identifying cancers that would otherwise not be receiving any treatment," said Constance Lehman, a professor of radiology at the University of Washington and the study's lead author.

Breast cancer strikes about 200,000 women a year and kills about 40,000. As much as 10% of women who are diagnosed with cancer in one breast are expected to eventually develop it in the other over the next ten years. With traditional mammography, those additional breast cancers are detected slowly, at a rate of about 1% a year.

The 3% detection rate found in the study indicates that broader use of MRIs "would mean earlier detection and that translates into much longer-term survival," said Phil Evans, director of the Center for Breast Care at the University of Texas Southwestern Medical Center, in Dallas. Dr. Evans was not involved with the study.

Its release coincides with the American Cancer Society's announcement of new MRI screening recommendations for women at high risk for developing breast cancer. The guidelines were outlined in an accompanying editorial in the New England Journal. Citing recent research in the field, they call for women to receive annual MRIs if they know they have certain related gene mutations or have a 20% to 25% higher lifetime risk of breast cancer because of factors such as a strong family history of breast or ovarian cancer.

Robert A. Smith, the editorial's author and the society's director of cancer screening, estimated that as many as 2% of all women over the age of 30 would fall under the parameters of the new recommendations.

He and other researchers cautioned, however, that the quality of breast MRIs varies widely around the country. In his editorial, Mr. Smith noted that many facilities that offer MRIs don't perform image-guided biopsies, a fact that results in some patients having to repeat the MRI procedure.

[RobinP]

Anybody interested in this topic please see general boards and look for my post on MRIs.
Thanks, I want to know what others are doing for screening or your thoughts about the new MRI recommendations.

[Lani]

ACS Advises MRIs for Some at High Risk of Breast Cancer: Get Scans Along With Mammograms, Not Instead of Them [American Cancer Society]
Certain women with an especially high risk of developing breast cancer should get magnetic resonance imaging (MRI) scans along with their yearly mammogram, according to a new American Cancer Society guideline. The two tests together give doctors a better chance of finding breast cancer early in these women, when it is easier to treat and the chance of survival is greatest.

MRI scans are more sensitive than mammograms, but they are also more likely to show spots in the breast that may or may not be cancer. Often there is no way of knowing whether or not these spots are cancerous short of a follow-up biopsy or some other invasive procedure. That is why the test is not recommended for women with an average risk of breast cancer, the guideline says.

"As with other cancer screening tests, MRI is not perfect and in fact leads to many more false-positive results than mammography," explains Christy Russell, MD, chair of the ACS Breast Cancer Advisory Group and co-author of the new guideline. "Those false-positives, which can lead to a high number of avoidable biopsies, can create fear, anxiety, and adverse health effects, making it imperative to carefully select those women who should be screened using this technology."

For women at average risk, ACS recommends getting annual mammograms and breast exams by a physician, beginning at age 40. Most high-risk women should begin getting MRIs and mammograms at age 30, the new guideline says, unless they and their doctor think it's better to begin at a different age.

Better Evidence for Many Situations

The new guideline is published in the latest issue of the ACS journal CA: A Cancer Journal for Clinicians. It recommends MRI screening in addition to mammograms for women who meet at least one of the following conditions:


they have a BRCA1 or BRCA2 mutation
they have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
they had radiation to the chest between the ages of 10 and 30
they have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative

The recommendations are based on studies that were published after the ACS last revised its breast cancer early detection guidelines in 2002-2003. At that time, the panel concluded there was not enough evidence to recommend for or against MRI in high-risk women, so the guideline advised these women to make the decision after talking with their doctor. Now there is more solid evidence that MRI is useful for certain women.

"These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than using mammography alone," says Russell, co-director of the University of Southern California/Norris Cancer Hospital Lee Breast Center.

More to Be Learned for Other High-Risk Situations

For some women, however, the jury is still out on whether MRI screening is beneficial, even though they have conditions that do give them a higher-than-average risk of breast cancer. The guideline says there still isn't enough evidence to recommend for or against MRI screening in women who:


have a 15%-20% lifetime risk of breast cancer, based on one of several accepted risk assessment tools that look at family history and other factors
have lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
have atypical ductal hyperplasia (ADH)
have very dense breasts or unevenly dense breasts (when viewed on a mammogram)
have already had breast cancer, including ductal carcinoma in situ (DCIS)
Screening MRIs are not recommended for women with a lifetime risk of breast cancer below 15%.

MRI Also Useful in Contralateral Diagnosis

Although the ACS guidelines find screening MRIs of uncertain value for breast cancer survivors, a newly published study shows the scans can be useful for finding tumors in the opposite (contralateral) breast of women newly diagnosed with the disease.

As many as 10% of women with breast cancer develop a new tumor in the opposite breast, even though nothing is found when they are checked with mammograms and physical exams at the time of their original diagnosis. Finding these cancers earlier could help women make treatment decisions (some women with cancer in just one breast opt to have both breasts removed as a precaution), and might spare them from extra rounds of surgery and chemotherapy later.

Researchers from the University of Washington Medical Center in Seattle studied 969 newly diagnosed breast cancer patients to see if MRIs could find contralateral cancers that mammograms and physical exams missed. The scans found 30 early-stage tumors the other tests could not detect, and missed only 3.

"This study gives us a clearer indication that if an MRI of the opposite breast is negative, women diagnosed with cancer in only one breast can more confidently opt against having a double (or bilateral) mastectomy," says John E. Niederhuber, MD, director of the National Cancer Institute, which sponsored the study.

The results appear in the New England Journal of Medicine. The study was released to coincide with the publication of the new ACS guidelines for MRI screening in high-risk women.


OPEN ACCESS: American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography [CA: A Cancer Journal for Clinicians]
New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recommended for women with an approximately 20-25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.



MRI Detects Most Missed Opposite Breast Cancers in Women [Brown University]
PROVIDENCE, R.I. [Brown University] — Up to 10 percent of women newly diagnosed with cancer in one breast develop cancer in the opposite breast. Results: of a major clinical trial show that magnetic resonance imaging (MRI) scans are highly effective tools for quickly identifying these opposite breast cancers, detecting diseased tissue that other screening methods missed.

In the new trial, conducted by the American College of Radiology Imaging Network (ACRIN) and funded by the National Cancer Institute, researchers wanted to determine whether MRI could improve doctors' ability to identify these opposite breast cancers right at the initial diagnosis - boosting the chances for swift and successful treatment.

The results, published in the New England Journal of Medicine, show that for women already diagnosed with cancer in one breast, MRI scans detected more than 90 percent of cancers in the opposite, or contralateral, breast.

"The study establishes MRI as a key component of the diagnostic workup for women with breast cancer," said Constantine Gatsonis, lead statistician for the trial and director of the Center for Statistical Sciences at Brown University. "If my wife were diagnosed with breast cancer, I'd be sure that she got an MRI of the opposite breast."

Gatsonis, a Brown professor of biostatistics, oversaw design of the MRI trial and led analysis of its results. He offered a caveat: The study showed that MRI is an effective addition to - but not a replacement for - clinical breast exams and mammography.

"This study wasn't designed to determine whether mammography or MRI is a better screening test for breast cancer in women at average risk," Gatsonis said. "It was designed only to see if MRI improved detection of cancers in the other breasts of women already diagnosed with unilateral breast cancer."

In the trial, 1,007 women were recruited from 25 clinical sites in the United States, Canada and Germany. A total of 969 women completed the study. All were recently diagnosed with cancer in one breast and had been cleared of cancer in the opposite breast; mammogram and clinical breast exam results came back negative.

Within 90 days of those tests, the trial participants then had an MRI. In 30 women, the scans turned up cancers missed by other methods.

"MRI is a powerful tool," Gatsonis said. "But it isn't perfect. Scans did show areas of suspicious breast tissue that turned out to be benign. But this study showed fewer false positives than smaller MRI studies - strongly supporting MRI as a complement to mammography."

Gatsonis heads the Biostatistics Center for ACRIN, a National Cancer Institute-funded cooperative group conducting clinical trials of diagnostic imaging and image-guided therapeutic technologies in 100 academic and community sites around the world. The network's goal is to generate information that lengthens and improves the quality of the lives of cancer patients.

Through ACRIN, Gatsonis oversees the Digital Mammography Imaging Screening Trial, a national study comparing digital and film mammography, and ACRIN's arm of the National Lung Cancer Screening Trial, which is comparing spiral computed tomography (CT) and standard chest X-rays for detecting lung cancer. The National Cancer Institute supports both studies.


OPEN ACCESS: MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer [New England Journal of Medicine]
Background: Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer.

Methods: A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up.

Results: MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor.

Conclusions: MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.