Research Roundup: Breast Cancer Breakthroughs
How effective is that MRI your surgeon scheduled? If your genetic testing was negative, are you really off the hook? Tamoxifen and Evista may be free to some, starting this fall.
MRI as a diagnostic tool – a waste of money?
Last month, The Journal of Clinical Oncology – a highly respected source of cancer research news – published results of a study of MRI (magnetic resonance imaging) and breast cancer. The study was accompanied by a seemingly surprising editorial: a call to stop routinely using MRI as an “information gathering” tool prior to breast surgery, particularly breast conservation surgery (lumpectomy).
So, why is the effectiveness of this highly developed technological tool being questioned?
According to the study, a major meta-analysis involving more than 3,000 women worldwide, MRI simply doesn’t improve outcomes for the vast majority of women whose surgeons use it. Except in rare (and identifiable) cases, it doesn’t reduce the risk of a woman’s cancer coming back; nor does it reduce her risk of dying from breast cancer.
But…isn’t more information always helpful? MRI is a sensitive test that can reveal far more about a breast tumor than a mammogram can: its exact size, location, and any tiny areas of spread within the breast, details a mammogram simply can’t pick up.
Well, in the case of most breast cancer diagnoses, this level of detail simply isn’t necessary. The surgeon removes the tumor; checks for clean margins; the patient has radiation to “clean up” any existing cancer cells, and hopefully, that’s it; the cancer is gone. For most women, following up with years of hormone therapy adds a final layer of protection against recurrence.
While MRI, unlike mammograms or other X-ray based tools, isn’t physically dangerous; it’s definitely expensive. The typical breast MRI will cost over $1,000, ten times as much as a simple mammogram. And whether insurance pays for it (and recovers the cost via higher premiums); or you pay out of pocket, that’s a lot. So why shell out big bucks for something that’s not going to help?
For women with Paget’s disease; certain BRCA-driven cancers; or breast cancer that’s first discovered via its metastasis to another part of the body, MRI has a proven benefit. But for the rest of us? If your surgeon suggests it, you might want to carefully weigh the non-benefit against the large cost.
Negative BRCA results – are you off the hook?
We all carry BRCA genes; one of their jobs is to suppress tumors in our bodies. But for those of us whose BRCA genes are damaged (mutated), the result is a much higher risk of breast cancer than normal; those carrying damaged genes can have a lifetime risk of up to 80%, far beyond the national average of 12 percent.
So, if someone in your family is found to be carrying mutated BRCA genes, what do you do? You might choose to undergo genetic testing, to see whether you carry the genes, too. If you’re a carrier, you know your cancer risk is higher than normal; if you’re not, your risk isn’t any greater than any other woman’s – right?
England’s M6-Inherited Cancer study, an 18-year-old ongoing study of 800 families affected with mutated BRCA genes, announced in November that new data showed women whose families carry the damaged BRCA2 gene, even if they themselves don’t have the mutation, are four times more likely than the average woman to be diagnosed with breast cancer.
Have you been tested for BRCA gene mutations, as so many of us have? Check your results; if your family history involves BRCA2 (not BRCA1) gene mutations, even if you’re not a carrier yourself, you’re at increased risk of breast cancer (as well as melanoma, and ovarian, pancreatic, and stomach cancers).
Tamoxifen and Evista – free to high-risk women, starting this fall
If our new national health-care plan, the Affordable Care Act, is still around in its present incarnation next September, you may find you’re eligible for free breast cancer prevention drugs – though there are some caveats.
First, these drugs won’t be free to women taking them to prevent recurrence – which is the vast majority of us. Only healthy women (no history of breast cancer) at high risk of developing breast cancer will be able to get prescriptions for tamoxifen or Evista without a co-pay, and without meeting a deductible.
Has your doctor assessed and shared with you your personal breast cancer risk? If not, ask about it. If your risk is high due to family history, breast density, or a range of other factors, it’s worth considering lowering it via drugs. Especially when you can pick them up without taking out your credit card.
Breast cancer study findings: The "why" behind high cholesterol link; negative BRCA2 result not an "all clear' sign. (2013, November 28). Retrieved from http://www.cleveland.com/healthfit/index.ssf/2013/11/breast_cancer_study_findings_the_why_behind_high_cholesterol_link_negative_brca2_result_not_an_all_clear_sign.html
Galewitz, P. (2014, January 09). For high-risk women, some breast cancer drugs to be free. Retrieved from http://www.medscape.com/viewarticle/818867
Houssami, N. (2014, January 06). An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence. Retrieved from http://jco.ascopubs.org/content/early/2014/01/06/JCO.2013.52.7515
Mulcahy, N. (2014, January 08). Stop routine use of pre-op MRI in breast cancer. Retrieved from http://www.medscape.com/viewarticle/818867