A recent study conducted by the Fox Chase Cancer Research Center questions whether MRI scans should be conducted routinely for women already diagnosed with breast cancer.

After thoroughly reviewing 557 breast cancer cases at the center, principal researcher and co-director of the breast fellowship program, Dr. Richard J. Bleicher, says that there is "no data" to back up the assertion that MRI improves patient outcomes for women who have moved beyond the initial stage of diagnosis and are in treatment planning. According to his research, women who had an MRI after being diagnosed were 1.8 times more likely to opt for mastectomy than those with similar disease states and tumor size who did not undergo MRI screenings. The study also found that there was a correlation between MRI use and delays in treatment, which Dr. Bleicher attributes to scheduling and follow-up consultations.

The medical literature supporting the routine use of MRI in these cases typically states that MRI scans change the treatment plan, but the Fox Chase study suggests that changing the plan isn't always best for the patient.

"This, in combination with the fact that MRIs have a high false positive rate, and are associated with an increase in mastectomy use, stage for stage in our study, is concerning," says Dr. Bleicher. "We have also demonstrated that it does not assist the surgeon in obtaining negative lumpectomy margins, nor help choose which women are best suited for breast conservation, as demonstrated by an equal number of conversions to mastectomy in those having MRIs and those who do not. Since breast conservation has been proven to be equivalent to mastectomy long before MRIs were ever used, the benefit of MRI remains very questionable."

Dr. Bleicher says that MRI's extreme sensitivity reduces specificity on the exams and that MRIs have been found "to cause a significantly greater number of unnecessary biopsies when compared with other breast imaging modalities."

The study concluded that women who had preoperative testing done with MRIs were at a disadvantage and might be spooked by the sensitivity of the exams into undergoing more extreme and invasive forms of treatment.

"Interestingly, we do know that well before MRI was ever in use, lumpectomies with postoperative radiotherapy conferred a survival that is the same as mastectomy."

Dr. Bleicher advises that MRI is appropriate either when clinical data conflicts or when other modalities have been shown to be inadequate in imaging the cancer. A cancer that MRI may be a good modality for is lobular carcinoma, which is difficult to image clearly.

The study has shaken things up in the imaging community and put some on the defensive, but Bleicher says that physicians at Fox Chase are supportive.

"Prospective trials need to be performed, such as the COMICE trial currently underway in the UK," says Bleicher. "Additionally, true outcomes, such as local recurrence and survival, are the end points that need to be pursued."

The study does not address whether MRI is a superior modality for women who have not yet been diagnosed with breast cancer, or whether dedicated breast-MR technologies would provide the same incidence of false-positives.

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