ammunition vs "but breast mris may have too many false positives"

[Lani]

The number of false positives, is much lower if you have had a baseline MRI(13%) or get them regularly(5.6%):


Radiological Society of North America
Repeat MRI screening for breast cancer results in fewer false positives

OAK BROOK, Ill. – MRI screening for breast cancer delivers consistent rates of cancer detection and fewer false-positive results over time, according to a new study published online and in the April print edition of Radiology.

While MRI can be more effective than mammography at identifying suspicious areas of the breast, it is not always able to distinguish between cancerous and benign lesions, which can result in additional testing and false-positive results that may cause anxiety for patients. A screening exam is considered to be false positive when its results recommend further testing or a biopsy of a suspicious finding, but no cancer is found.

"MRI is an excellent screening tool for breast cancer, but the higher rate of false-positive results keeps some women from undergoing the exam," said the study's co-author Martha B. Mainiero, M.D., director of the Anne C. Pappas Center for Breast Imaging at Rhode Island Hospital and associate professor of diagnostic imaging at The Warren Alpert Medical School of Brown University in Providence, R.I. "The goal of our study was to determine if the availability of prior MR images for comparison reduces the rate of false positives associated with the initial MRI breast screening exam."

In the study, researchers reviewed reports from 650 consecutive screening MRI breast exams performed on women between September 2007 and December 2008 at Rhode Island Hospital. The women, who ranged in age from 25 to 81 years, were referred for MRI screening because they were considered to be at high risk for breast cancer.

Of the breast MRI results reviewed, 307 were the patient's first, or baseline, screening exams and 343 were annual or repeat screening MRI exams.

In the baseline group, MRI identified two cancers for a cancer detection rate of 0.65 percent. In the repeat screening group, the cancer detection rate was nearly twice as high: cancer was found in four patients, for a rate of 1.17 percent.

Women undergoing a baseline exam were nearly four times more likely to be recommended for a follow-up MRI exam in six months to monitor suspicious findings (31 of 307 women, or 10.1 percent) than patients who had one or more prior MRI exams for comparison (9 of 343 women or 2.6 percent). The rate of false-positive results was 13 percent (39 of 299 patients) in the baseline exam group and 5.6 percent (19 of 341 patients) in the annual exam group.

"False positives are a risk of the breast MRI procedure, but the rate decreases following the initial round of screening," Dr. Mainiero said. "This information should provide reassurance for high-risk patients who are considering undergoing annual MRI screening exams."

###
"Screening Breast MRI: Comparison of Interpretation of Baseline and Annual Follow-up Studies." Collaborating with Dr. Mainiero was Gil Abramovici, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)

RSNA is an association of more than 46,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on breast screening and MRI, visit RadiologyInfo.org.

[Jean]

Big Thanks Lani,
I have been having MRI's once per year - glad to hear the more they see me the more they know me. (teehee)

All kidding aside, I am glad to read this article as it only confirms my feelings that MRI's are an additional
method to keep track of my health.

Kind Regards,
jean

[Hopeful]

At my last follow-up visit, my surgeon said her practice was going to start ordering breast MRI's on all patients who have had lumpectomies. I was then told I would have to first go for a preliminary test, to see if the dye used in the MRI would damage my kidneys. Since I still see my rads onc for follow-up (I am in a clinical trial comparing partial breast irradiation to standard radiation therapy), I asked her opinion on it when I saw her.

She told me that this is very controversial still; that conferences of radiation oncologists devote entire days to seminars on how to follow up bc patients. She told me in her opinion, my chance of having a local recurrence or a new cancer in the unaffected breast was 5% lower than the false positive rate for breast MRI's, and that I should decline this screening.

This report says that the high false positive rate associated with the initial screening goes down upon repeated screenings. However, if you have had a lumpectomy and rads and the initial false positive is to the treated breast, there are healing issues associated with having biopsy surgery performed on the irradiated breast.

I asked my rads onc about insurance coverage for this test, and here is the rub: she said that for women with dense breasts who have never had bc but want to have breast MRI, insurance will likely not pay for it. However, if you have had a lumpectomy already and your doctor writes the rx for the breast MRI to "follow up scar tissue," insurance will likely pay for it. So, the people who would most benefit from the test in having their initial bc dx early and who would not have compromised healing following a false-positive biopsy will likely be the people who will not have insurance coverage for the test.

Hopeful

[Becky]

As many here know (and new members not), I had cancer simultaneously on both sides. At that time, I knew nothing and went with 2 opinions that both told me to have double lumpectomies. My right was Stage 2 cancer with a positive node (and Her2+), my left side was low grade dcis. I had rads on the right but not on the left.

My surgeon and rad onc (2 differing ones with the same opinion) was to not get an MRI ONLY because the first one would show so much stuff (as I have normal for me "boulder" sized scattered calcifications plus the ravishes of 2 breast surgeries on both sides (to get wide margins on both lumpectomies). One respected rad onc said that I would have so many false positives that would HAVE to be investigated (opening up a Pandora's box). Then, after those biopsies, the next MRI would again be different and I would be on a roller coaster ride. Everyone says that since I had my ovaries removed and I am on Arimidex, there is no dense tissue in my breasts (big problem prior to cancer) and that my mammos are so easy to read and my breast exams so easy to do. They recommend a big fat no. However, I am still thinking about it because my sister just finished up rads for a high grade dcis so I know (or feel) I will never really be out of the woods with this disease and sometimes fret about a new one (totally new) just popping up. I do wish I knew more at the time and just had both breasts removed and that's a hard decision to make now after being NED for over 6 years. Time will tell but I did make the commitment to myself that even if the smallest thing happens - both "girls" go.

[Gerri]

I have had yearly MRIs for several years now. My surgeon feels they are more accurate than mammograms and recommended that I only have MRIs. I have had two false positives in the last few years - one with a mammogram and one with an MRI. This kind of stuff doesn't bother me. It is stressful at the time, but I guess I am willing to deal with the stress just to make sure everything is okay.

I saw a new oncologist and she recommended that I add the mammograms back in. I had my first one in two years yesterday and everything came back clear. I feel better having both tests done and will deal with additional testing if and when it is necessary.

[Rich66]

ultimatAlthough typically not done, I wish ramifications of false positives were discussed relative to false negatives..I believe up to 30% in mammos by some measures. Whicely h issue suffers the patient more "anxiety"? How many here have had those only to delay treatment? Too many. And yes...insurance coverage is likely a larger player in this than sometimes suggested. A couple years before mom's recurrence (outside the breast), I pressed for an MRI which led to much discussion and even a meeting with the head of radiology at an NCI facility. At some point I asked him if there was any medical reason to not pursue it, he said NO. We had been asking them to go ahead with it, even agreeing to pay out of pocket if not covered. Still..there was concern and a meeting was held. After all the talk, it was done and Medicare covered it. The plan from then on was to alternate between mammo and MRI.
Of course, in hindsight, should have been asking for a PET/CT.

[Hopeful]

Just to clarify, my surgeon is not advocating replacing mammograms with MRI's, but rather adding MRI's to mammograms. The reason being, MRI's do not show calcifications, which are often one of the telltale signs of bc, and mammograms do.

Hopeful