Can you ever have too much information?
When is it NOT in your best interest to have yet another test?
The answer to those two questions might very well be “Yes,” and “When you’re scheduled for a breast MRI.”
Dr. Richard Bleicher of the Fox Chase Cancer Center in Philadelphia, speaking at the annual breast cancer symposium of the American Society of Clinical Oncology (ASCO) in Washington, D.C. earlier this month, is one oncologist who thinks the MRI might just be an overused test that’s actually hurting more women than it helps.
Bleicher noted that women who undergo MRIs start their treatment an average of 3 weeks later than women who forego the test, which has become increasingly popular, especially for younger women, in recent years. And this despite its admitted shortcomings, including a large number of false-positive readings.
MRI (magnetic resonance imaging) is a tool for breast-cancer screening, one often used as a follow-up to mammography. Able to pick up smaller tumors than a standard mammogram, it’s been recommended by the American Cancer Society for screening women in certain high-risk groups: those 30 and older with a mutation in the BRCA1 or BRCA2 genes; those who received radiation therapy for Hodgkins’ disease between the ages of 12 and 18; and those with a strong family history of breast cancer, including two or more close relatives with breast or ovarian cancer, or a close relative who developed breast cancer before the age of 50.
But in recent years, more and more women are asking for (and more and more doctors are prescribing) MRIs as a routine adjunct to mammography, especially when a tumor has been identified. Since one cancer has been found via a mammogram, it’s possible there are additional tumors, ones the mammogram missed; they should be dealt with. So what’s the problem? Isn’t more information a good thing?
Not necessarily. As Dr. Bleicher noted, adding the MRI to an already long battery of tests delays surgery, or the start of chemo or radiation. Since most breast cancers grow very slowly, this delay probably won’t affect the eventual outcome of treatment. But it subjects the woman to 3 weeks of waiting… and we all remember what THAT’S like.
One of the hardest parts of treatment is knowing cancer is in your body, wondering if it’s spreading, and wishing you could have surgery already, for crying out loud. Also, coming right after your diagnosis, when the emotional wound is still fresh, the last thing you want to do is add more stress to your already shocked system. And, trust me; there’s nothing like lots of time on your hands for ratcheting your fears and distress to their highest possible levels.
“We have yet to see any evidence that MRI improves outcomes when used routinely to evaluate breast cancer, and yet more and more women are getting these scans with almost no discernible pattern,” said Bleicher. “MRI is a valuable tool in some women, but without evidence that routine pre-treatment MRI improves a woman’s outcome, its disadvantages suggest that it should not be a routine part of patient evaluation for treatment,” he concluded.
Dr. Constancer Lehman, head of breast imaging at the University of Washington Medical Center, decried Bleicher’s study as being too small to offer useful conclusions. "This is one abstract from one center that did one study in a very select group of patients,” she noted, adding that research on the value of MRI when used in breast cancer treatment decisions is evolving, and not all the answers are in yet.
Nevertheless, you might want to think twice about getting an MRI as a routine part of breast screening. Unless you’re in one of the high-risk groups outlined by the American Cancer Society, you might very well want to spare yourself weeks of anxiety; save money (MRIs are 10 times more expensive than mammograms); and perhaps avoid unnecessary surgery, by foregoing that MRI.
Published On: September 11, 2008