MRI Better at Detecting Breast Cancer in.......

[Guest guest]

MRI better at detecting breast cancer in women with BRCA1 or BRCA2

gene mutation

http://www.medicalnewstoday.com/?newsid=13423

14 Sep 2004

If a woman carries the BRCA1 or BRCA2 gene mutation, an MRI is better

at detecting her breast cancer than alternatives, such as

mammography, ultrasound or clinical breast examination, says a new

study published in JAMA, September 15 Issue.

Women with BRCA1 and BRCA2 mutations who do not undergo prophylactic

surgery have a lifetime risk of breast cancer of up to 85 percent,

with a significantly higher risk of breast cancer than the general

population from age 25 years onward, according to background

information in the article. Current recommendations for women who

have a BRCA1 or BRCA2 mutation are to undergo breast surveillance

from age 25 years onward with mammography annually and clinical

breast examination (CBE) every 6 months; however, many tumors are

detected at a relatively advanced stage. Magnetic resonance imaging

(MRI) and ultrasound may improve the ability to detect breast cancer

at an early stage.

Ellen Warner, M.D., of Toronto-Sunnybrook Regional Cancer Centre,

Toronto, Ontario, Canada, and colleagues compared the sensitivity and

specificity of four methods of breast cancer surveillance

(mammography, ultrasound, MRI, and CBE) in women with hereditary

susceptibility to breast cancer due to a BRCA1 or BRCA2 mutation.

The study included 236 women aged 25 to 65 years with BRCA1 or BRCA2

mutations who underwent 1 to 3 annual screening examinations,

consisting of MRI, mammography, and ultrasound at a teaching hospital

between November 1997 and March 2003. On the day of imaging and at 6-

month intervals, CBE was performed.

During the study period, there were 22 cancers detected (16 invasive

and 6 ductal carcinoma in situ). Of these, 17 (77 percent) were

detected by MRI vs. 8 (36 percent) by mammography, 7 (33 percent) by

ultrasound, and 2 (9.1 percent) by CBE. All 4 screening modalities

combined had a sensitivity of 95 percent vs. 45 percent for

mammography and CBE combined.

" This study of 236 BRCA1 and BRCA2 mutation carriers demonstrates

that the addition of annual MRI and ultrasound to mammography and CBE

significantly improves the sensitivity of surveillance for detecting

early breast cancers, " the authors write. " … our results support the

position that MRI-based screening is likely to become the cornerstone

of breast cancer surveillance for BRCA1 and BRCA2 mutation carriers,

but it is necessary to demonstrate that this surveillance tool lowers

breast cancer mortality before it can be recommended for general

use. "

(JAMA. 2004; 292:1317-1325. Available post-embargo at

http://www.jama.com)

Editor's note: This work was supported by grants from the Canadian

Breast Cancer Research Alliance, The Terry Fox Foundation, and

funding from the International Breast MRI Consortium, the (Canadian)

National Breast Cancer Fund, and the Papoff Family. The MRI contrast

agent was supplied by GE Healthcare.

Editorial: Breast MRI for Women With Hereditary Cancer Risk

In an accompanying editorial, Mark E. Robson, M.D., and

Offit, M.D., M.P.H., of the Memorial Sloan-Kettering Cancer Center,

New York, write that Warner et al have clearly documented the risks

and benefits of breast MRI screening in women at the highest levels

of hereditary risk.

" Their findings, in combination with those of [another recent study],

strongly suggest that women with BRCA mutations should be offered

such screening. Women and their physicians must, however, be aware

that both sensitivity and specificity of screening MRI may be

substantially less than described if different imaging protocols are

followed or if experienced radiologists and suitable technology,

including the capability to perform magnetic resonance-guided

biopsies, are not available.

" A technology assessment by one large insurance carrier has already

supported the rationale for MRI screening of BRCA mutation carriers

and other women at high hereditary risk for breast cancer, even in

the absence of a randomized controlled trial demonstrating a

mortality benefit. Remaining questions, largely centered on

specificity, recall rate, and positive predictive value, argue

against routine application of MRI screening for women at lesser

degrees of risk without carefully designed studies, preferably

randomized controlled trials, delineating test performance in those

specific populations, " the authors conclude.

(JAMA. 2004; 292:1368-1370. Available post-embargo at

http://www.jama.com)

Contact: Fiona

JAMA and Archives Journals Website

Breast Cancer News is brought to you by BREAST CANCER OPTIONS, a

grassroots organization focusing on Health Advocacy, Support and

Education. The information is intended for educational purposes only,

in order to help you make informed health choices and may not have

been touched upon by your doctors. We are not doctors and we do not

recommend any particular treatments. We are sending this information

to advise you of the complete scientific overview that is currently

available, although we may not necessarily endorse it.

http://www.breastcanceroptions.org

[Guest guest]

do you know what scares the hell out of me......my right side has always given me problems.....always sore.......always having the bad reports..

suspicious mammogram's...it just BLEW my mind when it was my keft side...ever have a feeling? well I sure do have it for my right side....I hope not.....but I sure do......

I think they should give MRIs to woman with suspicious mam,,,,,,,,

Judy

-- MRI Better at Detecting Breast Cancer in.......

MRI better at detecting breast cancer in women with BRCA1 or BRCA2 gene mutationhttp://www.medicalnewstoday.com/?newsid=1342314 Sep 2004If a woman carries the BRCA1 or BRCA2 gene mutation, an MRI is better at detecting her breast cancer than alternatives, such as mammography, ultrasound or clinical breast examination, says a new study published in JAMA, September 15 Issue. Women with BRCA1 and BRCA2 mutations who do not undergo prophylactic surgery have a lifetime risk of breast cancer of up to 85 percent, with a significantly higher risk of breast cancer than the general population from age 25 years onward, according to background information in the article. Current recommendations for women who have a BRCA1 or BRCA2 mutation are to undergo breast surveillance from age 25 years onward with mammography annually and clinical breast examination (CBE) every 6 months; however, many tumors are detected at a relatively advanced stage. Magnetic resonance imaging (MRI) and ultrasound may improve the ability to detect breast cancer at an early stage. Ellen Warner, M.D., of Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada, and colleagues compared the sensitivity and specificity of four methods of breast cancer surveillance (mammography, ultrasound, MRI, and CBE) in women with hereditary susceptibility to breast cancer due to a BRCA1 or BRCA2 mutation. The study included 236 women aged 25 to 65 years with BRCA1 or BRCA2 mutations who underwent 1 to 3 annual screening examinations, consisting of MRI, mammography, and ultrasound at a teaching hospital between November 1997 and March 2003. On the day of imaging and at 6-month intervals, CBE was performed. During the study period, there were 22 cancers detected (16 invasive and 6 ductal carcinoma in situ). Of these, 17 (77 percent) were detected by MRI vs. 8 (36 percent) by mammography, 7 (33 percent) by ultrasound, and 2 (9.1 percent) by CBE. All 4 screening modalities combined had a sensitivity of 95 percent vs. 45 percent for mammography and CBE combined. "This study of 236 BRCA1 and BRCA2 mutation carriers demonstrates that the addition of annual MRI and ultrasound to mammography and CBE significantly improves the sensitivity of surveillance for detecting early breast cancers," the authors write. "… our results support the position that MRI-based screening is likely to become the cornerstone of breast cancer surveillance for BRCA1 and BRCA2 mutation carriers, but it is necessary to demonstrate that this surveillance tool lowers breast cancer mortality before it can be recommended for general use." (JAMA. 2004; 292:1317-1325. Available post-embargo at http://www.jama.com) Editor's note: This work was supported by grants from the Canadian Breast Cancer Research Alliance, The Terry Fox Foundation, and funding from the International Breast MRI Consortium, the (Canadian) National Breast Cancer Fund, and the Papoff Family. The MRI contrast agent was supplied by GE Healthcare. Editorial: Breast MRI for Women With Hereditary Cancer Risk In an accompanying editorial, Mark E. Robson, M.D., and Offit, M.D., M.P.H., of the Memorial Sloan-Kettering Cancer Center, New York, write that Warner et al have clearly documented the risks and benefits of breast MRI screening in women at the highest levels of hereditary risk. "Their findings, in combination with those of [another recent study], strongly suggest that women with BRCA mutations should be offered such screening. Women and their physicians must, however, be aware that both sensitivity and specificity of screening MRI may be substantially less than described if different imaging protocols are followed or if experienced radiologists and suitable technology, including the capability to perform magnetic resonance-guided biopsies, are not available. "A technology assessment by one large insurance carrier has already supported the rationale for MRI screening of BRCA mutation carriers and other women at high hereditary risk for breast cancer, even in the absence of a randomized controlled trial demonstrating a mortality benefit. Remaining questions, largely centered on specificity, recall rate, and positive predictive value, argue against routine application of MRI screening for women at lesser degrees of risk without carefully designed studies, preferably randomized controlled trials, delineating test performance in those specific populations," the authors conclude. (JAMA. 2004; 292:1368-1370. Available post-embargo at http://www.jama.com) Contact: Fiona JAMA and Archives Journals Website Breast Cancer News is brought to you by BREAST CANCER OPTIONS, a grassroots organization focusing on Health Advocacy, Support and Education. The information is intended for educational purposes only, in order to help you make informed health choices and may not have been touched upon by your doctors. We are not doctors and we do not recommend any particular treatments. We are sending this information to advise you of the complete scientific overview that is currently available, although we may not necessarily endorse it. http://www.breastcanceroptions.org