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Saturday, February 13, 2010 tburden, Community Member, asks

Q: Should I have an MRI after being diagnosed with DCIS on a Mammogram?

I was interested in learning more about Mammosite so I went in for a second opinion on my DCIS.  This doctor is a fellowship trained breast surgeon at the only place around here offering Mammosite 5-day therapy.  She told me I am not a good candidate for Mammosite, which is fine; I just felt I should look into it.  Anyway, she did ask me if I'd had an MRI yet.  The first surgeon I went to feels that they do not provide much of a benefit to women in my situation (46, no family history of breast cancer, lesion < 1 cm.)  I have an individual  insurance policy with a hefty co-pay so while I want great treatment, I also want to be sure I am not spending a couple of grand for what my first surgeon considers a slim margin of benefit. Does anyone have any input that may guide me here? 

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Answers (2)
Phyllis Johnson, Health Guide
2/13/10 5:33pm

  A mammogram by itself cannot diagnose cancer, so I'm guessing you have already had a biopsy.  An MRI is not necessary if the surgeon feels that the image on the mammogram and the pathology report from the biopsy gives enough information to know what type of surgery you will need.  You can read more about DCIS in this article.  I wish you the best as you discuss this with the doctor and make your decisions.

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tburden, Community Member
2/14/10 10:28am

Wow, I'm so glad you can figure out what I am trying to say!  Thank you for the input: I'm trying to gather as much data as I can (without going crazy in the process) before I make my decision and every little bit helps.

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Phyllis Johnson, Health Guide
2/14/10 3:38pm

Glad to help.  Stay in touch.  You'll probably have more questions as you continue through this process.  Best wishes for a full recovery.

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PJ Hamel, Health Guide
2/13/10 6:54pm

Hi - An MRI is often used to determine treatment options after a woman has been diagnosed with breast cancer. It can find tiny additional tumors in the same breast, small enough that they can’t be felt, nor seen on a mammogram. It’s also invaluable for finding tumors in the other breast. If the “healthy” breast shows nothing suspicious on an MRI, it’s pretty certain there’s nothing there. This information is key if a patient is trying to decide whether to have a prophylactic double mastectomy.

Still, the number of false positives can be daunting. A recently completed study at Dartmouth-Hitchcock Medical Center in Lebanon, NH, reported in Dartmouth Medicine magazine, examined women with newly diagnosed invasive breast cancer who received followup diagnostic MRIs in the healthy breast. Of the 199 women monitored, 74 (47%) were found to have suspicious lesions in the opposite breast, lesions not picked up by a mammogram.

Of those 74 women, 38 (just over half) were discovered to have cancerous tumors (three-fourths of which were invasive) in their “healthy” breast; while in 36 women, the suspicious lesions were found to be benign, via biopsy.

 

Now, notice that the study was on women with invasive cancer, while you have DCIS. So the study results don't really apply to you exactly... And while the MRI might very well pick up more cancer (DCIS or invasive), it also might result in false positives and unnecessary biopsy or biopsies. And then there's the cost...

 

So, tough decision. Sorry I can't really guide you here - only you know how much you'll worry going forward. But I did want you to have some more data to consider. I'll tell you this, though - if it was me, knowing what I know now, I'd skip the MRI and just be super-vigilant about noticing breast changes going forward. Good luck - PJH

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tburden, Community Member
2/14/10 10:39am

I'm leaning that way myself; it seems that without a history of breast cancer in my family, (and with a clear mammogram) I might reasonably expect the rest of my breast to be relatively healthy at this point  I make my own decisions, but am definely into polling my resources.  You guys (and this site) are invaluable, that you so much for the input.

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PJ Hamel, Health Guide
2/14/10 11:16am

Glad you found us; here's hoping your treatment goes smoothly and well. And please stay in touch - we're here for you. PJH

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By tburden, Community Member— Last Modified: 01/26/11, First Published: 02/13/10