Should I insist on MRI before starting rads?

tlfrank

I'm scheduled to start radiation treatments next week. I have dense breasts and have never had an MRI. My Breast Surgeon initially said my mammogram was "busy" on both sides and consulted with radiologist who did biopsy about the need for MRI and decided against doing one.

I've been reading that if I have a occurrence down the road I would not be a candidate for reconstruction after mastectomy. Should I insist on an MRI? I'm concerned about proceeding to radiation, and would appreciate to hear opinions/experiences.

MTwoman

tlfrank, I can share my story with you, if it will help you make your decision. I was initially diagnosed when I was 38. DCIS seemed like such good news (if there can be such a thing), that my nurse navigator encouraged me to get a second opinion on the pathology (original pathology done by local hospital) so that nothing was missed. I used an expert in DCIS (Dr. Michael Lagios) who recommended an mri based on the architecture pattern of my dcis (it commonly presents as mult-focal) and my age. The report came in the DAY before I was supposed to go into my rads mapping apt. Tough decision. I put my rads on hold and flew to an mri breast imaging center. They found 2 more areas of concern in another quadrant that hadn't been previously seen. Shock. After getting them biopsies, more dcis was discovered. I then had to go back and get mx for best prognosis. I've frequently thought about what might have happened had I not gotten the mri. Would I have been one of the women who get a local "recurrence"? (but for me would have been cells that were never removed) I don't know, maybe rads would have killed them? It seems like such an important thing, not leaving 'bad' cells behind. I'd want the mri.

Luckynumber47

After IDC was found in my left breast my dr ordered an MRI and it found DCIS in the right. I'll be forever that dr ordered the MRI

Sourisou

Hi tlfrank, I agree with MTwoman. I'm not a doctor so I don't know the reason why your team don't see the need for an MRI (a potential delay in treatment caused by false-positives?), but you say it yourself, you have dense breast (so do I). For people like us, I feel MRI is a must. My DCIS wasn't visible on mammo nor ultrasound for the last 6 months. Only the MRI picked it up. DCIS is a sneaky beast, and since you are Grade 3 I would at least ask the doctors their reasoning in not pushing for it.

tlfrank

I had a phone consult with my breast specialist this morning. She said that since I've already had a lumpectomy, at this point the MRI would be invalid for the left side due to the hard lump caused by the healing process. Also, if I don't do rads now that I've had the lumpectomy I would greatly be increasing my chances of it coming back.

She said that nothing in my pathology indicates that there were any invasions and no other evidence of DCIS anywhere else. My options are to go ahead with rads, or blindly do the mx without any evidence of more DCIS.

Everything about this feels wrong - I feel trapped. She did say that if there were a occurrence, there are things that can be done to reconstruct the breast. I guess I'm going to have to go into this believing that it will never rear it's ugly head again.

MTwoman

tlfrank, saying an mri would be "invalid on your left side" is confusing to me, since I clearly had a lx and snb on my right side, followed by an mri on that same side (that found more areas of dcis - which also had given no clue that they were there). Not sure why they say that is a problem for you.

tlfrank

Me neither, MTwoman - This is all very confusing to me. She made perfect sense when I was talking to her. She did make a comment that my tissues were dense only under the nipple area (which is where my DCIS was) and that the rest of my tissues were imaged clearly on the 3D mamo.

Sourisou

tlfrank, that's really disappointing, and frustrating

Is it possible for you to have a second opinion before the start of rads? MTwoman mentionned Dr. Lagios, he's is an expert in DCIS treatments - I'm wondering if he could help in your situation? I'm not sure how resources are for breast cancer in your area but I think you deserve another opinion on this...

Annette47

I agree with having a second opinion. In my case, I didn’t have an MRI at any point, but I was told that my breasts were not unusually dense and were easy to read on mammo. For people with denser breasts, it seems like a good option.

I’m also concerned that they said a MRI would be invalid because of the lumpectomy. When I go in for mammograms, they have me put a tape marker on my lumpectomy scar so that they know which area has scarring/etc from surgery. I can’t see why they wouldn’t be able to do something similar for a MRI. The radiologist could then ignore anything that lights up in the surgical area, but still check the rest of the breast .... which is why I think you need a second opinion.

tlfrank

Thanks for the advice - I'll look into trying to get one prior to starting rads. Hopefully my insurance will cover - as they require referrals for everything.