MRI and Mastectomy: Too Much Knowledge?

PJ Hamel Health Guide
  • Magnetic resonance imaging (MRI) is a much more sensitive tool for identifying breast disease than the standard mammogram. And its usage as a breast cancer diagnostic tool has increased precipitously over the past 10 years. A new study shows that older women who’ve had an MRI are much more likely to opt for mastectomy or bilateral mastectomy in place of a lumpectomy (breast conservation surgery: BCS), even though there are many more risks – and no proven benefit – to the more aggressive surgery.

     

    Why would a woman choose to cut off her breast(s) when there’s no apparent medical reason to do so?

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    In the case of the older women followed in a large, long-range study whose results were released last month, the answer is fear –precipitated, apparently, by an MRI.

     

    The study, released in the journal Breast Cancer Research and Treatment, included more than 72,000 older (age 67-94) American women diagnosed with breast cancer between 2000 and 2009. During that time period, the use of MRI as a diagnostic tool prior to treatment increased from just under 1% to just over 25%. (MRIs, 2013)

     

    What researchers discovered was that women who had at least one MRI prior to the beginning of treatment were more than three times as likely (12.5% vs. 4.1%) to have both breasts removed compared to those who didn’t have an MRI. In addition, the MRI group was 3 1/2 times as likely (7% vs. 2%) to have both breasts removed, even when cancer was found in only one breast. (Ibid)

     

    MRIs discover more cancers than mammogram. But they also identify more pre-cancers: atypical groupings of cells that, in all probability, would never become “true” cancer: invasive, life-threatening cancer.

     

    Still, women who hear the word “cancer,” even when it refers to pre-cancer, tend to panic. “I want this gone out of my body. I don’t want to take any chances. Just take off my breast, so I don’t have to worry about it.”

     

    It’s a natural reaction; but unfortunately, one not grounded in scientific fact. 

     

    According to the study’s lead author, Dr. Cary Gross of the Yale School of Medicine, “…the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear. Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit to the more aggressive option.” (Peart, 2013)

     

    Adds Dr. Brigid Killelea, first author of the study, “Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer.” 

     

    In fact, data shows that for women in all age groups, mastectomy reduces the risk of cancer recurrence in the affected breast by about 90%, but doesn’t eliminate that risk; nor does it reduce the risk of dying from breast cancer, compared to a simple lumpectomy (breast conserving therapy) followed by radiation

     

    If you’re a woman of any age who’s been diagnosed with breast cancer; and an MRI reveals additional areas of atypical cells (DCIS), don’t let your fear overrule the facts: there’s no evidence that removing your breast(s) will reduce your chance of dying from breast cancer. 

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    Mastectomy – particularly bilateral mastectomy – comes with many possible complications, including permanent shoulder issues, lymphedema, and the need to consider and perhaps undergo reconstruction surgery. Do you really want to face all of that – for no proven benefit?

     

    Think about it.

     

    Sources

     

    MRIs may spur unneeded mastectomies in older women with breast cancer. (2013, August 14). Retrieved from http://health.usnews.com/health-news/news/articles/2013/08/14/mris-may-spur-unneeded-mastectomies-in-older-women-with-breast-cancer

    Gross, C. (2013, August). Trends and clinical implications of preoperative breast MRI in medicare beneficiaries with breast cancer. Retrieved from http://link.springer.com/article/10.1007/s10549-013-2656-1

     

    Peart, K. (2013, August 14). Growing use of MRIs leading to more invasive breast cancer surgery. Retrieved from http://news.yale.edu/2013/08/14/growing-use-mris-leading-more-invasive-breast-cancer-surgery

     

Published On: September 08, 2013