Marked background enhancement on MRI?

bruinjamie21

Hi everyone... I'm 42, very high risk, but no KNOWN genetic abnormalities in my family. I alternate MRIs and Mammos every 6 months. I had an MRI biopsy 2 years ago that was benign. Obviously each time I go I'm on edge. My results from yesterdays MRI were just posted, and I haven't had a chance to speak with my Dr. yet, but curious if any of you have any expertise? What bothered me were THESE WORDS - Marked background enhancement, significantly increased from prior studies.

It's a BiRADs 3, with suggestion for ANOTHER follow up MRI in 6 months (UGH). Here's the full report:

CLINICAL HISTORY:

Dense breasts, family history of breast cancer (mother, grandmother, and

cousin), lifetime risk of breast cancer 20.9% according to a modified Gail

model. High-risk screening.

COMPARISON:

11/1/2019 MRI, 6/9/2020 mammogram, and earlier prior studies

FINDINGS:

There is marked background enhancement, significantly increased from prior

studies, limiting the sensitivity of breast MRI, with the potential for

obscuring underlying significant abnormalities. Multiple areas of non-mass

enhancement throughout both breasts are all similar in appearance, multiple, and

bilateral, therefore probably all part of the same process of increased

background enhancement, therefore probably benign. Short-term follow-up MRI is

recommended in 6 months. No suspicious lymphadenopathy is seen.

--

IMPRESSION:

Marked background enhancement, significantly increased from prior studies,

limiting the sensitivity of breast MRI. Multiple areas of non-mass enhancement

throughout both breasts have an appearance most suggestive of bilateral

increased background enhancement, all similar in appearance, multiple, and

bilateral, therefore probably all part of the same process of increased

background enhancement. Short-term follow-up MRI is recommended in 6 months.

FINAL ASSESSMENT BIRADS CATEGORY 3 - PROBABLY BENIGN, SHORT INTERVAL FOLLOW-UP

IS RECOMMENDED (MR6MON)

LivinLife

Hi bruinjamie! I'm limited in the medical knowledge department with these kinds of things. At the same time I have a few basic comments. The BIRADS 3 is a good indicator, as is the 6 months and statement about probably benign. Obviously with you being high-risk and a change noted they will continue keeping a closer eye on you. I'm not sure the odds on non-mass enhancements benign/nefarious... I can say I had a large area of non-mass enhancement on MRI. Upon final pathology, after surgery, it was a mix of lots of different benign and precancerous issues. The surgeon's P.A. told me had I not chosen bilateral mastectomy I had call back after call back with many biopsies in my future - again these were not cancerous conditions though pre- which have to be monitored or addressed (e.g., biopsy, excision, etc.). Others will come along to comment more on the medical aspects you listed....

MelissaDallas

It sounds like they set you for a repeat because this one wasn’t optimal quality due to the background enhancement, which when bilateral usually just means your estrogen level was higher at the time of the test. Maybe done at a different time in your menstrual cycle.

https://radiopaedia.org/articles/background-parenchymal-enhancement-breast-mri?lang=us

Beesie

Normal breast tissue can enhance. I would think that with the enhancement being bilateral and similar in both breasts, it is suggestive of some change in your breasts that is not cancer. I'm guessing that's why your radiologist assigned a BI-RADS 3.

Could this relate to your time of month? MRIs should be done right between your cycles, but I know that when I was 42, my cycles were becoming very irregular thanks to peri-menopause so I sure wouldn't have been able to time things well.

The hormone levels in our bodies fluctuate a lot during peri-menopause (it's like being a teenager again!) and that can affect how breast tissue appears on an MRI. And our breasts certainly change as we go through peri-menopause and menopause. I wonder if that might be driving this. Are you on any new medications?

If it were me, because the changes are the same in both breasts, this report wouldn't cause me any concern. Breast cancer is rarely bilateral, and when it is, it often isn't the same presentation or diagnosis in one breast vs. the other. So the consistency across both breasts would be reassuring to me.

I noticed that a year ago you posted asking whether you should see a genetic counsellor. Did you ever see one? I'm thinking that might be where the Gail score came from. Not that this will make you feel any less concerned, but to my understanding, 20.9% just edges you into the high risk category (here in Ontario "high risk" is considered 25% or higher but I believe the Gail model uses 20%). To be honest though I'm surprised that your Gail model estimate isn't higher, with your mother and grandmother both having had breast cancer, and having had a biopsy yourself. But 'very high risk' usually refers to 40% risk or higher, or those who have genetic mutations (BRCA, for example) that could confer a risk as high as 70% or 80%. That said, with your family history and the breast issues you've had before, I certainly understand your concern. It's good that you are able to get MRI screenings.

bruinjamie21

Thank you SO MUCH for this response. It's reassuring and makes total sense! Getting old stinks LOL. They have me schedule the MRIs between day 1 and 14 I believe in the cycle, so this was in that time frame, although like you said, who knows how things are "changing." And YES, I too was surprised by the percentage! It doesn't take into account my maternal 1st cousin who was diagnosed at 31 either, I don't think? Maybe it is time to see that genetic counselor. I did speak with my surgeon this afternoon, and she was NOT concerned, and told me not to worry about having to have another MRI in 6 months. She also doesn't think I am at the point where I should do anything prophylactically except the monitoring, I wonder if she's just pretty conservative about those things given my lack of a genetic mutation. Anyways, thank you SO MUCH for the thorough answer to my concern, this community is so wonderful

AliceBastable

When I had genetic counseling, they didn't ask about cousins, just parents, siblings, aunts and uncles. Cousins have too many genetic differences due to the non-related parent, from what I understood.