MRI Emerges as Breast Cancer Tool
CancerWise - May 2008
By Dawn Dorsey
Being female in Mary Mujica’s family is a dangerous proposition. Only a few women have lived past 60, and breast and ovarian cancer appear all too frequently throughout the family tree.
When she found out she carried a breast cancer gene called BRCA1, Mujica was not shocked. Neither was she when she was diagnosed with the disease. What did surprise her was that a magnetic resonance imaging (MRI) scan found her cancer, and a mammogram did not.
She’s convinced that the MRI saved her life by catching the tumor at an early stage. Imaging specialists tout its effectiveness.
“MRI is emerging as the most sensitive modality for detection of primary or recurrent breast cancer,” says Wei Tse Yang, M.D., associate professor and chief of breast imaging in M. D. Anderson’s Department of Diagnostic Imaging. “It has shown to be a powerful diagnostic tool, but it's still rarely used in clinical practice, as compared with other traditional applications of MRI.”
To help educate the medical community about the potential of breast MRI,
M. D. Anderson researchers are studying its benefits and clarifying guidelines they have developed for its use.
Two sisters succumbed to cancer
Of Mujica’s three sisters, two died of cancer in their early 50s. When one of the sisters was fighting cancer, she and Mujica participated in a University of Chicago study examining families with a high incidence of breast and ovarian cancer. Participation included screening for the BRCA1 gene.
Mujica, an elementary school teacher in Brownsville, Texas, got the call telling her she carried the breast cancer gene on the same day in 2004 that she had a partial hysterectomy to treat another condition.
“They said, ‘Is there a cancer center near you? How fast can you get there?’ ” she recalls. “I immediately went to M. D. Anderson.”
MRI reveals cancer
At M. D. Anderson, Mujica consulted with Banu Arun, M.D., co-director in the Clinical Cancer Genetics program and associate professor in the Department of Breast Medical Oncology.
As part of the standard of care for patients possessing the BRCA1 gene, Mujica had a mammogram and an MRI.
“Lo and behold, the MRI picked up a very small tumor, about 1 centimeter, close to the chest wall, and the mammogram did not detect it,” Mujica says.
Mujica had chemotherapy, and then she chose to have a bilateral mastectomy (surgical removal of both breasts), even though the cancer was only in one breast. The non-cancerous breast was removed as a preventive measure, in case cancer were to later develop in that breast.
The surgery was followed by 30 daily rounds of radiation therapy and reconstruction surgery.
Next month, Mujica will have surgery to remove her ovaries because she faces a 50% chance of developing ovarian cancer. There is no sign of breast cancer now, and she goes to M. D. Anderson every three months for follow-up tests.
MRI can be a valuable tool
Two years ago, M. D. Anderson formulated guidelines to advise physicians when to refer patients for breast MRI scans. Since then, several publications, including the New England Journal of Medicine and Lancet, have published similar guidelines.
“We want to be careful not to make generalizations,” Yang says. “However, our message is that breast MRI is a powerful tool if used judiciously.”
Yang says breast MRI should not be regarded as a first-line tool for all women. "If not judiciously used, MRI may be associated with high cost and low gain," she says. "All said, breast MRI has proven its value in screening women at high risk and has shown ability to diagnose early cancers that are not always visible with mammography and ultrasound."
M. D. Anderson advises breast MRI if a patient has:
- Newly diagnosed breast cancer (for staging)
- Suspicious but inconclusive mammogram and ultrasound
- Breast cancer in lymph nodes that doesn’t show up in either:
- Nipple discharge but no abnormal findings in either:
- High risk of recurrence after radiation therapy
- A need for gauging the response to chemotherapy
- Suspected rupture of breast prostheses/implants
- High risk of either:
- Breast cancer
- BRCA 1 or 2 gene mutation
Yang stresses that women in the above categories who believe breast MRI might be appropriate should visit dedicated breast imaging centers where their MRIs will be read by breast imaging specialists who also have the expertise to perform necessary MRI guided biopsies.
“Women should not have breast MRIs at a general imaging center,” she says. “For this test to be effective, the professional needs a high level of specificity. A general center may not always have that expertise or supporting facilities available.”
M. D. Anderson resources:
CancerWise - May 2008
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- Q&A: Services Young Cancer Patients Need
- MRI Emerges as Breast Cancer Tool
- Body Mass Index Linked to Some Breast Cancers
- Ovarian Cancer Patients Need BRCA1/2 Facts
- Rare Ovarian Cancer More Difficult to Treat
- Mind-Body Practices Good for Cancer Patients
- Web Site Makes Cancer Prevention Fun, Easy