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1 year ago
Breast MRI Linked to More Aggressive Surgical Treatments

Listen up if you or someone you know is considering a breast MRI. The use of preoperative breast MRI is on the rise, and women who have received one are more likely to undergo more aggressive surgery afterward, according to a new study published online in the journal Breast Cancer Research and Treatment.

Researchers looked at women over the age of 67 who were diagnosed with breast cancer between 2000 and 2009. Overall, the use of preoperative MRIs increased from 1 percent in 2000 to 25 percent in 2009, and it was more popular among the younger women. Surprisingly, women who received a preoperative MRI were more likely to subsequently have a mastectomy rather than breast-conserving surgery (BCS). Plus, rates of bilateral mastectomies (surgical removal of both breasts) and contralateral prophylactic mastectomies (surgical removal of both breasts when cancer is only in one breast) were higher in women who had an MRI compared to women who had other screening methods, like a mammography or ultrasound.

Why Experts Are Worried “What’s concerning is the use of MRI, which is disseminating so rapidly, is associated with more extensive surgery,” says study co-author Brigid Killelia, M.D., assistant professor of surgery at Yale School of Medicine. However, prior research has not found evidence for an increased survival rate in women with mastectomy versus breast-conserving surgery, explains Killelia. And unfortunately, more extensive surgery typically comes with a higher risk of complications, higher medical costs, and longer recovery time.

Experts aren’t sure why more women are receiving preoperative MRIs or why it might lead to more drastic surgical choices. It may be the case that the women who request an MRI are more likely to later choose a more aggressive surgery, though it may also be the case that doctors who prefer mastectomies are more likely to request a complete workup (including MRI) for their patients, says Killelia.

Another factor could be the increased media attention on aggressive or preventative surgery—like Angelina Jolie’s recent preventative double mastectomy—is shaping patients’ concerns and choices. “Patients are often concerned about the rate of recurrence,” says study co-author Cary Gross, M.D., associate professor of internal medicine at Yale School of Medicine. “That’s understandable. But we as providers have to help patients understand what their risk of recurrence is and not let that fear of recurrence drive the therapy that they’re getting for their early stage breast cancer.”

Are MRIs Harmful? It’s important to note that this study found a correlation between preoperative MRI and more extensive surgery, but that doesn’t necessarily mean that one causes the other. “Our data did not prove that MRIs are causing the more aggressive surgery,” says Gross—though he stresses that there seems to be some kind of association that warrants further research.

Unfortunately, there is no one-size-fits-all guideline to decide who needs a breast MRI. “It’s important for women to work with their doctors to decide what their risk factors are and what the benefit of an MRI might be in terms of surgical therapy,” says Killelia, “Every case is different.”

photo: iStockphoto/Thinkstock
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