Breast MRI scans resulted in higher mastectomy rates and delayed treatment for women who received them, according to a study to be published in the August issue of the Journal of the American College of Surgeons.
A research team led by Dr. Richard Bleicher of Fox Chase Cancer Center in Philadelphia reviewed the records of 577 patients who were treated in a multidisciplinary breast clinic. Of these, 130 patients received breast MRI scans prior to treatment.
The patients who received the breast MRI scans had a 22-day delay in the start of their treatment, Bleicher said. The researchers also expressed concern that the false-positive rate of breast MRI scans might be leading women into choosing mastectomies rather than more conservative therapy, such as lumpectomy: Breast MRI did not reduce conversions from breast-conserving therapy to mastectomy (9.8% MRI versus 5.9% no MRI).
The study also indicated that younger women were more likely to have an MRI (52.5 versus 59.0 years), a trend that didn't correspond with various breast cancer risk factors, such as a family history of breast or ovarian cancer or the characteristics of their disease. Finally, the study found that breast MRI did not help surgeons decrease positive margins at lumpectomy (21.6% MRI versus 13.8% no MRI).
Recent studies have offered conflicting evidence regarding the relationship between breast MRI and mastectomy rates. A study of more than 5,000 women by Goetz and colleagues, which was presented at the American Society of Clinical Oncology (ASCO) annual meeting in 2008, found that more than half of the patients who got breast MRIs opted for mastectomy, compared with 38% of the patients who did not have MRIs.
On the other hand, a study presented in April 2009 by Carpenter et al at the American Society of Breast Surgeons (ASBS) meeting showed that 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.
Those findings were echoed by a study by Hollingsworth et al in the September 2008 issue of the American Journal of Surgery that found that breast MRI led to a rise in breast conservation when used selectively, and that it did not lead to treatment delays.
Related Reading
No rise in mastectomy rates with greater use of breast MRI, April 28, 2009
Rates of prophylactic mastectomy for DCIS rising in U.S., April 24, 2009
Preoperative breast MRI boosts breast conservation, October 9, 2008
New scans prompt mastectomies for breast patients, May 16, 2008
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