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Old 07-27-2013, 08:52 AM   #1
marigold
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Exclamation breast MRI with contrast

Hi, I am 5 years NED and my oncologist has suggested I have a breast MRI with contrast. I have heard there are many false positive results and, therefore, much anguish. Any thoughts or suggestions?

Last edited by marigold; 07-27-2013 at 12:04 PM.. Reason: add signature
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Old 07-27-2013, 10:55 AM   #2
'lizbeth
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Re: breast MRI with contrast

I am waiting for the results of my breast MRI. I am just over 5 years NED.

Yes, the big argument by the surgical staff against my MRI was the large incidence of false positives, their number 20%. This number being generated by the specificity of the MRI as compared to mammograms or ultrasound. MRIs pick up every little detail.

My argument for the MRI was the larger risk of false negatives 22% - 50% based on a study that I can email to you if have a history of Paget's Disease of the Breast.

My request for an MRI was based my personal history of Paget's, with 2 lesions of breast cancer that were only discovered on a subsequent MRI during my initial diagnosis in 2007.

I have dense breasts. I also have had a similar inflammation of the nipple areola complex, ability to express fluid of various colors from the nipple and tiny flakes or crusting.

I wanted the peace of mind from an MRI that would show the mammograms are not producing a false negative, again.

Your doctor must have expressed some reasons behind the recommendation of an MRI. If you can share some of your history, and these reasons we can help you explore why this could be a good option for you.

My feelings about a false positive is yes, there is some anguish about worrying of another recurrence. But I'd rather face a false positive than the repercussions of a false negative on the mammogram.
__________________
Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease

Last edited by 'lizbeth; 07-27-2013 at 10:56 AM.. Reason: better grammer?
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Old 07-27-2013, 11:00 AM   #3
'lizbeth
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Re: breast MRI with contrast

I found this posting on cancerfocus.net

Women with personal history of breast cancer should be screened with MRI

CHICAGO – Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

The American Cancer Society (ACS) guidelines currently recommend annual screening with breast MRI in women with a known gene mutation or with a strong family history indicating a lifetime risk of breast cancer greater than 20 percent. However, the guidelines say there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer themselves.

"In our study using breast MRI screening, we actually detected proportionally more cancers in women with a personal history of breast cancer, compared with those women with a genetic mutation or strong family history who are currently recommended to have breast MRI," said Wendy B. DeMartini, M.D., assistant professor in the Department of Radiology at the University of Washington Medical Center and Seattle Cancer Care Alliance in Seattle. "Further, women with a personal history were less likely to be recalled for additional testing and less likely to have a biopsy for a false positive MRI finding."

Dr. DeMartini and colleagues performed a retrospective review of initial screening breast MRI examinations of 1,026 women from January 2004 to June 2009. Of the 1,026 women, 327 had a genetic or family history of breast cancer and 646 had a personal history of treated breast cancer.

Overall, MRI testing identified 25 of 27 cancers in the group for a sensitivity rate of 92.6 percent.

The cancer yield in the women with a personal history of breast cancer (3.1 percent) was double that of the women with a genetic or family history (1.5 percent). Specificity in women with a personal history was 93.6 percent, compared with 86.3 percent for the other group. Specificity refers to the accuracy of the exam in correctly ruling out cancer where it is not present, resulting in lower recall and biopsy rates due to false-positive findings.

Biopsy was recommended in 9.3 percent of the women with a personal history of breast cancer, compared with 15 percent of the genetic and family history group. The positive predictive value of biopsy was also higher in the personal history group, with 35.7 percent of biopsies yielding cancer, compared with only 12.2 percent in the other group.

"Our findings show that the diagnostic performance of MRI in patients with a personal history of treated breast cancer supports consideration of screening MRI as an adjunct to mammography," Dr. DeMartini said. "Additional studies such as ours are necessary to establish guidelines for screening this important group of women."
__________________
Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease
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Old 07-27-2013, 11:19 AM   #4
marigold
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Re: breast MRI with contrast

Thanks for all the information, it certainly does cause me to consider doing this.

Last edited by marigold; 07-27-2013 at 11:19 AM.. Reason: typo
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Old 07-27-2013, 11:25 AM   #5
'lizbeth
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Re: breast MRI with contrast

If you have a history of BRCA in the family, a personal history of Pagets Disease of the breast or dense breasts, or any symptoms of breast cancer it could be helpful.

It helps me to go and research an idea and get back to my doctor when I have a better understanding.
__________________
Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease

Last edited by 'lizbeth; 07-27-2013 at 12:07 PM.. Reason: typo . . .
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Old 07-27-2013, 12:06 PM   #6
marigold
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Re: breast MRI with contrast

I have never been tested for BRCA. I do have dense breasts. Both of my Aunts and a Great Grandmother had Breast Cancer.
__________________
Diagnosed 1/2008, Left breast Invasive Ductal Cancer, 2.5 cm, Stage IIB,T2, N1, Grade 3, ER-PR-, HER2+++ by IHC, KI67 40%
Partial Mastectomy 1/24/2008
1/3 nodes micrometastases (1mm)
Power Port 2/2008
TCH started 3/2008
Herceptin 1 year ended 2/2009
Radiation 32 sessions, whole breast+boost and axillae
Zoledronic Acid 4mg. IV Q month @ 6 months, then 1X every 6 months for 30 months (Clinical Trial)
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Old 07-27-2013, 12:16 PM   #7
'lizbeth
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Re: breast MRI with contrast

If you haven't been tested for BRCA and you have a history of breast cancer in the family, the MRI your doctor suggested is a good idea. And another good reason is with the dense breasts.

Now the surgeons are obligated to check out anything they find, which would mean a biopsy, even with a false positive.

The actual breast MRI is not that bad, staying still for about 30 minutes, and the loud banging noise of the MRI equipment is the worst of it.

With the contrast, you might have a blood draw before the MRI to check the function of your kidneys to ensure the ability to eliminate the contrast.
__________________
Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease
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Old 07-27-2013, 03:13 PM   #8
marigold
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Re: breast MRI with contrast

Once again, thank you for all the great input/advice. I really appreciate it. Good luck on your results...I'll be watching to see if you post them.
__________________
Diagnosed 1/2008, Left breast Invasive Ductal Cancer, 2.5 cm, Stage IIB,T2, N1, Grade 3, ER-PR-, HER2+++ by IHC, KI67 40%
Partial Mastectomy 1/24/2008
1/3 nodes micrometastases (1mm)
Power Port 2/2008
TCH started 3/2008
Herceptin 1 year ended 2/2009
Radiation 32 sessions, whole breast+boost and axillae
Zoledronic Acid 4mg. IV Q month @ 6 months, then 1X every 6 months for 30 months (Clinical Trial)
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Old 04-08-2015, 01:02 AM   #9
dooori
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Re: breast MRI with contrast

Your doctor must have expressed some reasons behind the recommendation of an MRI. If you can share some of your history, and these reasons we can help you explore why this could be a good option for you?
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Old 04-25-2015, 08:54 PM   #10
Dakini52
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Re: breast MRI with contrast

'lisbeth, I have a question. I know you have participated in a vaccine trial and wanted your thoughts. I have the potential opportunity to participate in this trial: http://www.cancer.gov/clinicaltrials...thprofessional. Are you familiar with this trial and if so could you give me your thoughts. Thanks.
__________________
Diagnosed June, 2006 HER2+++, ER- PR-, Grade 3, Stage IIB. Modified radical mastectomy, radiation, chemo, Herceptin, Tykerb 1 year. [*]In remission until 2/2010. Small tumor detected on chest wall during routine scan. 2/2010 surgery to remove tumor, started Herceptin/Tykerb, follow up radiation. [*]12/26/2010 - Off Tykerb due to allergic reaction[*]12/16/2014 - Have continued on Herception for almost 5 years now and remain NED. Discussion with onc re adding Perjeta to the Herceptin as another way of preventing recurrence. Still in discussion phase. 12/26/14 Onc applying for approval for Perjeta.
Perjeta approved and I received one infusion. It had an immediate impact to my lungs and I experienced difficulty breathing so.....I'm going to be sticking with just Herceptin. Still looking for a good vaccine program to enroll in.

Debbie K
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Old 04-26-2015, 02:02 PM   #11
Catia
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Re: breast MRI with contrast

Debbie,
I think you can't be HER2 overexpressing (3+). This study is aiming at lower expressers like Her2 1+ or 2+,...not amplified. I tried to get into this one and that's what I was told back then and I ended up entering a different trial.
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Dx: April1st (yes April Fool's Day!), 2011
ER-/PR-/HER2+++ Tumor grade 3 size:1.6mmx1.2mm
Micromet to sentinel node, 5 auxiliary nodes were clear, stage 1B
April 13th, 2011 Double Mastectomy, no immediate reconstruction
May 2011 to Nov, 2011 chemo AC-TH plus
Herceptin until Sep 2012
11/2012 Began GP-2 vaccine at MD Anderson in Houston (monthly shots until April 2013), now receiving booster shots every six months
Began natural breast reconstruction with BRAVA procedure in Oct 2012
Oct 2012 First fat graft
Jan 2013 Second fat graft
March 2013 Third fat graft
July 2013 Final touch-up with nipple reconstruction
November 2013: Vaccine Booster #1
January 2014 Nipple tatooing
April 2014: Vaccine Booster #2
October 2014: Vaccine Booster #3
April 2015: Vaccine Booster #4 (trial finished)
Dec 2015: Scar treatment with Kenalog and laser
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