MRI before prophylactic MX?

windingshores

Hello folks,

I had a mastectomy of my right breast on March 6th of this year. I wanted a bilateral but have some health challenges and the surgeon convinced me to do one, to help with healing, and if I still wanted the other one, she would do it for me whenever I wanted. I now have surgery on my "good" breast scheduled on May 14th.

One cancer center I have dealt with always does an MRI on the good breast before removing, because a sentinal node biopsy/removal is not possible once the breast is gone (unless, like Angelina Jolie, you have them marked, which many surgeons won't do).

My surgeon says no, there is only a 2% chance of cancer in this breast, the MRI is an ordeal and results in false positives.

I would just want it to see if an SNB is needed before that becomes impossible. I have had sensations in this breast since before diagnosis, that resemble sensations in the other, and of course biopsy of my surgical specimen did show some things that don't show up on mammogram, mainly atypical hyperplasia. So I don't feel totally reassured by a negative mammogram.

It seems that more than 2% of women on this site had cancer found in their healthy breast- so that also may skew my level of concern.

Any advice? My surgeon did a fantastic job the first time and it would be easier to do it in the same place with the same MD. But I also see the wisdom in really checking out the healthy breast.

Thank you!

p.s. another MD said "Why would you have an MRI if it is coming off?" I guess my main concern is if any unknown cancer emerges in the "healthy" breast requires treatment different than the one already off, such as Herceptin.

inks

I know that with PBX for BRCA they usually do not do SNB. As far as MRI is concerned - if you did not have an MRI for your cancer breast why are you wanting one on a healthy breast? There is a study out there that MRIs before surgery for staging do not increase survival. This here is a different study but it mentions MRI for invasive cancer too http://www.mskcc.org/pressroom/press/mri-right-after-surgery-does-not-benefit-women-early-breast

MRI does not reveal HER expression so it would not benefit you there. I assume you did get an US on the healthy breast at diagnosis and that is sufficient. Unless your invasive cancer was lobular MRI will not reveal that much more. Bilateral synchronous BC is very rare.

Sarah0915

I had MRI on the breast with cancer prior to surgery. Never a mention of MRI on the other breast prophylactic mastectomy. However, the breast was evaluated in the lab for any signs of cancer.

windingshores

I did not have an MRI on the cancer breast because I was already having the sentinel nodes taken out. . The MRI of the healthy breast would be because no SNB is planned, to make sure that is wise. Ay question at all, they would do the SNB.

The point I was trying to make is that a major cancer center here feels that if any cancer is lurking in the "healthy breast," then mastectomy means no future possibility of sentinel node biopsy- no breast left to do the dye in. So if cancer is found, then all nodes would have to come out.

This cancer center requires an MRI for all prophylactic mastectomies, but other hospitals don't. Just another difference between cancer centers..

I have both ductal and lobular, both invasive and in situ.

inks

"So if cancer is found, then all nodes would have to come out." - Not true, they found cancer in mine and I did not get ALND. Newer research has shown that radiation is better than ALND if a few nodes are affected. Did your lobular invasive cancer show up on mammogram and ultrasound? If it did then any cancer in your healthy breast would have most likely shown up as well. If you really want an MRI get your MX at the center that does the MRI. I got an MRI even with SNB so I don't believe there is any connection between MRI and SNB, most women get SNB anyways. My MRI was to see if cancer had spread outside the breast.

windingshores

I don't necessarily want an MRI. I am just checking to see what is common practice, since the two cancer centers I deal with differ on this issue.

No, my lobular cancer did not show up on the mammogram or Ultrasound on the cancer breast.

Noone is going to do a sentinel node biopsy on my "good" breast unless an MRI shows reason to do one. Mammogram of that breast is negative, my breast is 50% dense. My current surgeon would just take it off.

A highly respected cancer center insists on MRI first before prophylactic, which made me wonder.

Also, I cannot have radiation due to another health issue.

Just wanted to know what other cancer centers do. It is not that common to have one off then the other off three months later, perhaps, but that was the most prudent course for me.

lovevt

windingshores I had a BMX

lovevt

sorry..I had a BMX april 28. DCIS in left and prophylactic on right.  My first surgeon was not going to do SNB on the right my second opinion said he would do both to be safe because once they do the mastectomy they cannot go back and just do SNB they would have to take many.  I at first did not like the idea of taking lymph nodes on the non cancer side but as I thought about it I decided to do it for peace of mind.  My DCIS was only diagnosed with MRI so I think if you are leaning to not do SNB then an MRI before is a good idea...much more sensitive to early stage cancers.  I have to say even  though there was no cancer in the right breast I am still happy they did the SNB on that side.  I have peace of mind that all was clear. 

I don't know if that helped...hope so.  Good luck!

windingshores

Thanks lovevt. I think it makes a lot of sense to do the SNB or at least an MRI beforehand. I am glad for you that that was done: peace of mind.