Mammogram vs MRI

[DeeUK]

I wonder if some of you could give me some advice on this please..

I've been informed that the hospital will be contacting me soon, for my '1 year post diagnosis mammogram'.

I'm 30, and I know mammograms tend not to be as reliable for younger people.
When they contact me, I intend to ask about the possibility of an MRI, instead.

I'm in the UK, and as far as I know, the majority of hospitals only offer mammograms. I have a feeling they're going to refuse to give me an MRI.
If they do refuse, I'm prepared to pay for it myself, if it's going to have a better chance of picking up any abnormalities, than a mammogram would.

I could do with a little guidance on this, so I'm armed with some information and knowledge, to face the medical folks with.
I'd really appreciate any help, advice and info, anyone may be able to give me

[Bev]

Hi Dee,

I had my 1 year mammogram and will be having an MRI in Oct. I think the plan is to alternate them every 6 mos for a while.

I would think at your young age, your breasts will be too dense to get a get a good view with the mammo. I had a 2.9 cm tumor turn up 5 mos after a mammo so I don't have a lot of confidence in them.

Definitely ask for an MRI. If you are only allowed a mammo try to get a newer digital machine. They're clearer images than film.

Good Luck, BB

[mekasan]

i second the MRI vote over the Mammo.

[AlaskaAngel]

NEW YORK (Reuters Health) - Magnetic resonance imaging (MRI) is "significantly more sensitive" than mammography in detecting multiple malignant foci in fibroglandular or dense breasts but not in fatty breasts, according to findings from The Italian Trial for Breast MRI in Multifocal/Multicentric Cancer published in the October issue of the American Journal of Roentgenology.

Dr. Francesco Sardanelli from the Istituto Policlinico San Donato in Milan and colleagues compared the sensitivity of MRI versus mammography for detecting additional malignant lesions in 90 women with breast cancer scheduled to undergo mastectomy (9 bilateral, 99 breasts).

Additional malignant lesions were detected more often by MRI than by mammography (152 vs 124). Pathologic examination of the whole excised breast -- the gold standard -- detected 188 additional malignancies.

According to Dr. Sardanelli, the malignancies that were missed by mammography were "significantly larger and more aggressive (70% were invasive cancers) overall than the malignant areas that were missed by MR."

MRI was most useful in women with dense breast tissue. In fibroglandular or dense breasts, the sensitivity was 81% for MRI versus 60% for mammography.

However, false-positive results remain a problem for both techniques, which have a "relatively low" positive predictive value, the authors report. The overall positive predictive value of 68% for MRI was not significantly different from the positive predictive value of 76% for mammography.

Previous studies have shown that up to 42% of women diagnosed with breast cancer in one breast have at least one other malignant lesion in the same breast. It's important to identify these other malignant areas to determine the best course of treatment, the authors note.

Based on the current findings, Dr. Sardanelli and colleagues believe that it would be worthwhile to perform a "dynamic MRI examination before treatment planning in patients with a nonfatty breast pattern."

The findings of the current study support those of several previous studies showing that MRI is more sensitive than mammography in the detection of breast cancer. (see Reuters Health reports September 15 and July 28, 2004, among others).

Am J Roentgenol 2004;183:1149-1157

[mts]

I also agree that an MRI is far better. After my initial bc diagnosis I joined a multi-modality trial at the University of Pennsylvania. The physical imaging they were comparing were mammos, ultrasound and breast MRI. Well, The MRI picked-up two tumors that neither the mammo or ultrasound saw. The MRI saved my life. The mammo they used was digital too. Plain and simple, if you have dense breasts (which most younger women have, then the MRI is the way to go. The one thing that MRI's do not pick-up are calcifications (which the mammo easily does). In the end, as useless as the mammo may be, it is still a good idea to get the mammo and ALSO the breast MRI.

Also, if you have scar tissue, this can mimic cancer on the MRI. Make sure you have the best person around to read your results. Preferably the radiologist (not the tech) will be in the adjacent room while you are getting your MRI.

Best to you,
Maria

[tousled1]

I agree that the MRI is the best route, especially for dense breasts. The MRIs pick up much smaller tumors than does a mammogram.

[DeeUK]

Thank you all for your advice

I'm going to print the article and take it with me next week. I'm going to see my breast care nurse to talk about a few things, and this is on my list.

And thanks Maria, for the info about MRIs/mammograms and calcifications.. I didn't know that.

I've just been speaking to someone who's 13 years older than me. Her 4.6cm tumour didn't show up on a mammogram! Doesn't fill you with much confidence about them, does it!

Thanks again for all your help

Love & hugs,
Dee
xxx

[sarah]

MRI shows more than a mammogram.
sarah

[G. Ann]

Hi DeeUK,

Keep trying for MRI and good luck -- My mammo in 2003 missed my tumor (even though I felt a lump, the OB/GYN felt a lump, and the tech felt the lump) because of dense breasts, even at 56 years old; the results stating normal mammo so I wasn't worried. Six months later I decided to have the lump/cyst drained and ended up with a 2.5 cm tumor. I had mastectomy in 2004. My HMO still will not order MRI even though I've had 4 cysts, microcalcifications, and a solid lump (supposedly does not show cancer) in remaining breast since 2004. They will only perform digital mammo. I got a price quoted outside of my HMO with my second opinion oncologist. His facility quoted me $4500 (US dollars) for one breast. I haven't shopped around though so this might be a very high quote.
G.Ann

[tousled1]

G. Ann,

If everyone could feel the lump but it didn't show up on the mammo, why didn't they do an ultrasound? Before I was diagnosed I felt the lump so my primary care physican ordered a "diagnostic mammogram." I'm not sure what the difference is between a regular mammo and a diagnostic mammo other than the ultrasound portion.

[G. Ann]

Hi Tousled1,I have had many cysts in both breasts for over 10 years. I always had them drained at the next doctor visit if I had appt scheduled or made a new appt. In 2003 the OB/GYN suggested doing the mammo first rather than draining lump during my office visit, which was a different strategy. When I received the mammo results in the mail, it said "normal," I let too much time elapse, six months, before going back in to have lump drained... just got complacent and thought "it's just a cyst, like always." About three months after the 2003 mammo, I started to experience pain. I stupidly thought I remembered reading that cancerous tumors did not cause pain, only cysts, so wasn't worried, plus no BC in my family history, and besides my past experiences showed it was always a cyst/cysts. Also, my son was having his wedding, my father was in a nursing home and I needed to visit him 2000 miles away, Christmas was around the corner, etc. and I just dragged my feet. Believe me, I beat myself up for over a year after diagnosis. My friends reminded me that I was always good about going to check lumps out. If I ever hear of anyone delaying action, I warn them of risks because you never know. Any and every lump should be examined and in my opinion not just with a mammo.

Before BC in 2004, an ultrasound was never used, just the FNA once lump felt. Four months after chemo stopped, I had ultrasound done for one lump that I could feel on remaining breast--it showed three new cysts plus the one I felt and all were eventually drained, but it took several months, and lots of crazy making time. Last mammo in 1/06 showed "loosely clustered microcalcifications," and recommendation was to "wait and watch" for 6 mos (so easy for radiologist to say) as they are "probably benign," then do another digital mammo, which will happen in July. I did feel another lump 3/06, went to surgeon, and it was biopsied showing no evidence of cancer, but I still have the lump and it's hard not to worry that microcalcifications are getting tightly clustered, meaning BC again. The above is the reason why I have been pushing for MRI.

So my new plan is to get the remaining breast removed this fall since HMO will not perform the MRI. The surgeon agreed he would do it although doesn't think it is medically necessary at this time. Sorry to be so lengthy, but my frustration level gets me going.
G.Ann

[mekasan]

I believe the difference between the diagnositic mammo vs the screening mammo is not the process, but rather the purpose. It is an insurance billing coding thing. If the doctor feels that there might be a problem, the laws say the insurance companies must cover certain tests. I think the extra ultrasound was just a backup diagnostic tool. I had both done when they were looking for my cancer. And then an MRI.

I know that when digital mammo came out, they were permitted for diagnostic mammos, but not used for screening mammos. I believe this was because there were not that many machines available and someone with power felt they should be reserved for the most serious cases.

Now these are just my middle of the night thoughts, so anyone, please correct me where I am misinformed.

Thanks

[tousled1]

GAnn,

Thanks for your reply. I too had cysts drained before my diagnosis. Have been dealing with fibrocystic disease all my life. When I found my last lump I knew in my heart that it was breast cancer -- it was hard and wouldn't move around. Didn't feel like all the other lumps I'd had. I delayed going to the doc -- was just recovering from major back surgery, applying for disability retirement and social security and last but not least, moving. I wonder sometimes if I had gone to doc as soon as I found the lump if things would be different now, but then I realize we should never second guess ourselves. Breast cancer is a terrible disease and I've adopted the attitude "one day at a time." I wish you all the best.

[MCS]

This is such a timely question for me also.

I'm due for my first mammo after dx. I was told by my ob/gyn and onc that the mri is more sensitive so I definitely will ask for it- I don't think my insurance covers it, just mammos.

HOWEVER, I also have fought fibrocystic breasts all my life, have dense breasts and have had benign and malignant calcifications. I have scar tissue from previous cysts removed and have had cysts drained as well.

Maria ( mts), THANK YOU-has indicated the calcifications information; that mammos are better for this. Do you remember where you saw this information? I want to bring it up to the docs.

I want to be able to see as much as possible, as little as they come and as soon as able.

I think I will call the radiologist that did my mammo last year ask for his opinion.

Thank you for reference to article, I am also going to print it

XO

Maria (MCS)

[AlaskaAngel]

As mts said, mammograms pick up calcifications. Ultrasounds and MRI's do not. Screening mammos are the basic pictures of each side, and diagnostic mammos are the views that are done if they think there is something questionable in the basic pictures that were taken in a particular area and they want a closeup of that, etc.

[mts]

Below is some helpful info re: calcifications and MRI vs Mammo. At that same site, you can look-up mammos and do some comparisons.



http://www.breastcancer.org/testing_mri.html


MTS