No rise in mastectomy rates with greater use of breast MRI
NEW YORK (Reuters Health), Apr 28 - Contrary to what some researchers have shown, increasing use of MRI in evaluating invasive breast cancer does not necessarily raise mastectomy rates, according to study findings presented Friday at the 10th annual meeting of the American Society of Breast Surgeons (ASBS) in San Diego.
“Several prior studies have demonstrated that as the use of breast MRI has increased, the rates of mastectomy have also increased. This is true despite the fact that for many patients the findings suspicious for additional cancer by breast MRI turn out not to be cancer,” lead author Dr. Susanne Carpenter, from Mayo Clinic Arizona, Phoenix, told Reuters Health.
The current study, she noted, is unique in showing that rates of breast-conserving therapy can be maintained if MRI is used selectively in patients at increased risk for additional cancer not yet detected with mammogram or ultrasound.
Such patients need to be informed that MRI might lead to additional biopsies and that the results of these biopsies and not just the MRI findings themselves will guide surgical decisions, she emphasized.
The study involved 814 patients who underwent surgical resection and sentinel lymph node biopsy at a single center from January 2003 to June 2008. MRI was performed at the surgeon’s discretion.
Overall, 69% of patients were treated with breast-conserving therapy, 18.6% with mastectomy alone, and 12.4% with mastectomy and reconstruction.
While the distribution of surgery types remained stable throughout the study period, a significant increase in MRI use was noted. From 2003 to 2008, MRI use rose from 19% to 45% (p < 0.001).
Genetic testing also increased during the study period, climbing from 5% to 16% (p = 0.004).
On multivariate analysis, the surgery type performed was significantly linked to tumor size, multifocality, age, and MRI use, but not with nodal status, tumor markers, body mass index, or results of genetic testing. MRI use was tied to multifocality, age, tumor size, tumor histology, body mass index, and genetic testing, but not with nodal status, tumor markers, or family history.
“The most prominent remaining question is whether patients who undergo breast MRI before breast cancer surgery have better results, namely lower rates of cancer recurrence, and if so for what patients,” Carpenter said. “This has not yet been demonstrated. We have many clinical trials ongoing at the Mayo Clinic in Arizona to investigate this and other breast cancer issues.”
By Anthony J. Brown, M.D.
Last Updated: 2009-04-27 14:15:24 -0400 (Reuters Health)
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