Breast MRI —Guidelines For Those at High Risk

Whether utilized to further investigate a suspicious lesion or as a screening tool, MRI’s high sensitivity in revealing small abnormalities can better determine the extent of breast cancer and the most effective treatment plan.

Actions speak louder than words. Milford Regional Medical Center's (MRMC) dedication to providing the very latest in diagnostics has been demonstrated over the years through millions of dollars invested and reinvested to maintain superior diagnostic care. MRMC upgraded to a 40- and 64-slice CT scanner, 4-D ultrasound and digital mammography. The response from the community was so great, MRMC installed a third digital mammography unit to keep up with demand.

This being said, when the American Cancer Society (ACS) recently recommended that women with an unusually high risk for breast cancer undergo MRIs along with their yearly mammograms, Milford Regional was already in the midst of acquiring this cutting edge technology.

According to Maria Gualtieri, MD, chief radiologist at Milford Regional, MRI of the breast is not a replacement for mammography or ultrasound imaging. It is a supplemental tool for detecting and staging breast cancer and other breast abnormalities. The ACS guidelines recommend annual MRIs for symptomless women age 30 and older who carry a mutation in the BRCA1 or BRCA2 genes; those who were treated for Hodgkin’s Disease; or those with a strong family history of breast cancer, including those with two or more close relatives who had breast or ovarian cancer or who have a close relative who developed breast cancer before age 50. Dr. Gualtieri adds that females, ages 10 to 30, who have had radiation therapy to their chest should also be included in this group. Experts state this applies to about one out of 50 adult U.S. women, which translates into as many as 1.4 million women.

Advances in breast cancer detection are responsible for a survival rate that continues to rise. The death rate from breast cancer in the U.S., which was 24 percent lower in 2003 than in 1989, can be attributed to early detection through conventional mammography. The advent of digital mammography that provides computer enhanced breast images benefiting those with dense breast tissue was another advancement in early detection. Now, those considered at high risk, have an even higher level of detection with MRI.

Magnetic Resonance Imaging (MRI) is a non-invasive procedure that uses a magnetic field and radio waves to produce cross-sectional, three-dimensional pictures of organs, soft tissues, bone and other internal body structures without the use of x-rays. In most cases, an intravenous line (IV) is inserted into the patient’s hand or arm for injection of a contrast material. The patient lies on a moveable bed that slides into the large, cylinder-shaped MRI magnet where images are produced and ultimately evaluated on a computer monitor.

Whether utilized to further investigate a suspicious lesion or as a screening tool, MRI’s high sensitivity in revealing small abnormalities can better determine the extent of breast cancer and the most effective treatment plan. It can show whether a breast cancer is one or multiple small tumors and if the cancer has spread into the chest wall. Studies have also shown that MRI scans of women diagnosed with cancer in one breast reveals 90 percent of cancers in the other breast that were not visible on mammograms. Since research has determined 10 percent of women diagnosed with cancer in one breast will develop it in the other, this news is significant. It allows physicians to treat both cancers upon the initial diagnosis.

According to Dr. Gualtieri, breast MRI is best at detecting invasive cancer which spreads outside the milk duct into the surrounding tissue. Because mammograms pick up calcifications that MRIs can’t, they are better at detecting non-invasive cancer which hasn’t spread outside the milk duct. With this in mind, Dr. Gualtieri states that together, breast MRI and mammograms are “useful and complement each other.”

This being said, it is important for women to understand why breast MRI is not recommended for everyone. Because a MRI’s high sensitivity picks up so many suspicious spots, chances of a false positive are estimated at 5 to 25 percent. This can lead to repeat scans and unnecessary biopsies that turn out benign. In addition, insurers do not always cover the cost of a breast MRI, which can range anywhere from $1,000 to $2,000. Plus, sheer availability of breast MRI needs to be taken into account since the entire exam takes approximately an hour and a half versus 10 to 15 minutes for a mammogram.

Breast MRI may not be for everybody, but if you fall into the ACS high risk category, it is meant for you. Dr. Gualtieri strongly advises women in this group to have a combination mammogram and breast MRI annually. The best offense is a good defense; Milford Regional is prepared on both fronts.