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Breast cancer

26 August 2019

Is MRI screening worth it for breast cancer survivors?

A new study found that when cancer survivors underwent MRI screening, it tended to detect more tumours, compared with yearly mammography alone.

Breast MRI screening is a good way to detect small tumours, but it's unclear how much it benefits women with a history of breast cancer, a new study finds.

Right now, experts recommend that breast cancer survivors have yearly mammograms to help catch any recurrences early. An unresolved question is whether adding breast MRI to that screening is beneficial.

A choice to make

In the new study, researchers found that when survivors underwent MRI screening, it did tend to detect more tumours, compared to yearly mammography alone. But it also more than doubled the number of biopsies women needed – many of which turned out to be benign.

Experts said it leaves women with a choice to make.

"Rather than deciding for women that the risks of any exam outweigh the benefits, we need to be clear and open about exactly what those risks and benefits are, and let them decide what's most important to them," said Dr Mary Newell, a radiologist at Emory University's Winship Cancer Institute in Atlanta.

Newell wrote an editorial accompanying the study published online in the journal Radiology.

Breast MRIs can catch some tumours not seen on standard mammograms, but they are also more likely to spot something that turns out to be benign, according to the American Cancer Society (ACS).

Because of that, MRI is reserved for women at high risk of breast cancer. (The average US woman has about a 12% risk.) Right now, the ACS recommends MRI, along with yearly mammograms, when women have a roughly 20% or higher lifetime risk of breast cancer.

Little research evidence

That group includes women who carry certain inherited gene mutations, or who have a particularly strong family history of breast cancer.

But it does not include women with a personal history of breast cancer.

That's because at the time the recommendations were made – in 2007 – "there simply weren't any good studies from which we could draw conclusions," said Robert Smith, vice-president of cancer screening for the ACS.

Even now, he said, there remains little research evidence.

The new study is the largest and most comprehensive to look at the issue so far, according to lead researcher Karen Wernli of Kaiser Permanente Washington Health Research Institute in Seattle.

Wernli and her colleagues combed through information on more than 13 000 breast cancer survivors who were screened for breast cancer at several sites across the United States. All together, they had received nearly 34 000 mammograms and about 2 500 MRI screenings between 2005 and 2012.

Overall, MRI caught more tumours – at a rate of 11 per 1 000 exams, compared to eight per 1 000 for mammography alone. To achieve that rate, though, the MRI group had to undergo more biopsies: 10% of those screenings led to a biopsy, compared to 4% of mammograms.

Potential broader impact

And while MRI detected more early tumours, it's not clear what the ultimate benefit is: The rate of "interval" cancers – cancers diagnosed in the year between screenings – was the same in the mammography-only and MRI groups.

That suggests, according to Wernli, that mammography did about as well as MRI in detecting tumours that were "clinically important" – small tumours that would progress enough to produce symptoms (like a lump) in the next year.

Wernli pointed to the potential broader impact of using MRI screening for all women with a history of breast cancer. If every US woman diagnosed with non-advanced breast cancer in 2018 underwent one MRI, there would be more than 14 000 additional biopsies.

For individual patients, however, those types of figures may not mean much, Newell pointed out. If, she said, a woman has a lot of anxiety about a cancer recurrence, for example, she might feel the higher odds of needing a biopsy are worth it.

The decision comes down to women discussing the pros and cons of MRI screening with their doctors, the experts said.

They also agreed that more research is needed to figure out whether MRI screening benefits certain breast cancer survivors more than others.

MRI costs substantially more

Smith pointed to some examples. It might be that women with dense breast tissue – which can make mammography interpretation harder – benefit more from adding MRI. The same could be true of women with a family history of breast cancer.

But studies are needed to find out, Smith said.

There are also practical issues. Breast MRI costs substantially more than mammography, and the ACS advises women to first check that their insurance plan covers it.

Image credit: iStock

 

Ask the Expert

Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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