mammo, MRI, both or??

Anyone come up with any conclusions over which way to go in a "dense breast tissue" situation? my limited research suggests an mRI is better than mammo but that maybe a mammo is still best for calcifications? Maybe one needs both? There is also a molecular breast imaging study being consucted at mayo Rochester.
My mom's primary BC was missed by mammo, found by CT. Calcifications that proved cancerous were found by mammo.

I Have Extremly Dense Breast. During My Mammo They Found The Ductal Carcinoma, But Only When They Did An Ultra Sound Did They Find The Lobular Carcinoma Inches Away From The Ductal. The Tissue Is Just Too Dense And "hides" The Lobular Kind. The Mri Is The Suggested Method And The Only Method Suggested To Dx This Kind. So Many Woman With Dense Breast May Have This Lurking And Not Know It. Reguardless I Would Not Trust A Mammo For Dense Breasts. Hope This Input Helps.

[karenann]

I am going to have a bilateral mri in two weeks. My breasts are very dense and last year when I was diagnosed, the mammo did not pick up the lump (that I could feel), so they gave me an ultrasound. However, neither the mammo or the us picked up the DCIS (huge amount) they found during my lumpectomy.

[kristen8594]

Hi,
I just wanted to let you know that if you can get both....then have both. My cancer did not show up on my mamo (even though you could see and feel the lump). Because of my very dense breast tissue my doctor orders an MRI along with a yearly mamo. The mamo can't see through the dense tissue but it DOES pick up any calcifications, where I think the MRI does not. So if you can have both...then it is a very good idea!
Thanks
Kristen

[mts]

I too have dense breasts... Fortunately, in 2004 I joined a "multi-modality trial" at U. of Penn where mammo, US and breast MRI were used for comparison. The MRI picked-up the cancer and the Mammo and US did not. If not for the MRI, I would still have tumors in my breast that my rad onc said were too big for radiation to kill. These tumors would have been my so called "recurrances".
Two lumpectomies and rads later, I still get MRI's just to be sure. The radialogy guys at UPenn stated that it is a good idea to do all three modalities -even if the mammo and US don't show anything because of the calcification issue...
On the other hand, the MRI does pick-up every little tissue that appears not normal and false positives are common. Next thing you know, you're having biopsies and chewing your nails down to the knuckle... in the end, its part of living with this stinkin' disease.

From what the radiologist told me from UPenn, the breast MRI caught 30% more cancer than the mammo and ultrasound combined. I was one of those 30%.

Often times the doc's won't suggest a breast MR because they are so expensive and insurance may not pay.

[jjfromcanada]

I have all three. The mammo and ultrasound are done together and the MRI is done 6 months later. My lump was missed when I only had mammos and I have dense breast tissue. Like everyone else in this thread.

[Alice]

If you can have both hopefully what one doesn't catch the other will.Personally I have more faith in the MRI. At the time of my surgery my surgeon told me he only goes by the MRI.

Good luck, Alice

[AlaskaAngel]

At 48 I had very dense breasts. Mammography picked up enough calcifications to be suspicious and led to more frequent mammograms every 6 months, and then to magnified views, and then to ultrasound along with mammogram at age 50. An ultrasound did pick up my cancer at about 1 cm at age 50 1/2. In looking at my mammograms at from age 48 to 50 it is easy to understand why it is difficult to detect cancer in dense breasts. The early mammograms show the tissue to be mostly like a thick forest of white branches , and since calcifications are white too and are very small, they are much harder to find or count accurately. After the lumpectomy and chemo I was started on tamoxifen. The mammograms after the chemo and 3 months of tamoxifen at age 52 are dramatically different, showing much less white branching. I hope that explains why mammos can miss cancers in people whose breasts are so dense from estrogen.

I hope this article helps too. You are right, the mammos still DO help to see the calcifications, and the MRI is good for high-risk dense breasts:

MRI more sensitive than mammography at detecting cancer in high-risk patients

Anthony J. Brown, MD
Reuters Health
Posting Date: July 28, 2004

Last Updated: 2004-07-28 17:00:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - MRI is more sensitive than mammography at detecting tumors in women with a familial or genetic predisposition to breast cancer, according to a report published in The New England Journal of Medicine for July 29th. The findings suggest that MRI be used in addition to mammography in this setting.

In the study, "MRI detected early, potentially curable cancers that in some cases were not picked up by mammography or physical exam," Dr. Laura Liberman, author of a related editorial, told Reuters Health. However, "MRI was a little less specific than mammography."

Despite the greater sensitivity seen with MRI, "I don't think this study suggests that MRI should be done instead of mammography," noted Dr. Liberman, from MemorialSloan-KetteringCancerCenter in New York. "In this study, there were some cancers that were seen with mammography, but not with MRI. So, I think the use of MRI we are considering in the high-risk screening setting is as a supplement to mammography."

The findings stem from a study of 1909 women who were screened for breast cancer every 6 months with physical exam and every year with mammography and MRI. All of the women had a cumulative lifetime breast cancer risk of at least 15% and 358 were carriers of germ-line mutations. The characteristics of the cancers detected in this group were compared with those of two age-matched control groups.

During a median follow-up of 2.9 years, 44 invasive cancers, 6 ductal carcinomas in situ, 1 lobular carcinoma in situ, and 1 lymphoma were detected, senior author Dr. Jan G. M. Klijn, from ErasmusMedicalCenter in Rotterdam, the Netherlands, and colleagues report.

MRI was found to have a significantly better overall discriminating capacity than mammography (p < 0.05). The sensitivity for detecting invasive breast cancer ranged from 17.9% for physical exam and 33.3% for mammography to 79.5% for MRI. The corresponding specificities of the three procedures were 98.1%, 95.0% and 89.8%.

About 43% of invasive tumors detected in the screening group were no greater than 10 mm in diameter, the authors note. In contrast, only about 13% of tumors in the control groups were of this size (p < 0.05). Similarly, the proportion of invasive tumors with axillary disease or micrometastases was significantly smaller in the screening group.

In high-risk patients, "mammography only picks up about half of their cancers -- the other half pops up in the interval between screens," Dr. Liberman explained. "So, it has been suggested that supplementing mammography and clinical exam with some other ancillary test may improve cancer detection. That's, I think, where MRI comes in."

Dr. Liberman said that further studies are needed to determine who will benefit most from MRI screening and how to integrate this modality into mammographic screening.

N Engl J Med 2004;351:427-437,497-500.

[Barbara2]

I'd opt for the MRI. Because of very dense tissue, my large, 4.5cm IDC was not found by a mammo or ultra sound. In the meantime, 8 months passed from the time I started questioning the thickening in one area of the breast...

Barb

[jhandley]

My second tumour (which I suspect was not a recurrence but was there all along) was not picked up by mammo. or ultrasound. The mammo. showed a couple of microcalc. but as it was hard to feel the lump a core biopsy had to be done. Go for MRI if you can get it.
Jackie