MRI

Sweaty, I had an MRI after my excisional biopsy after I asked the radiology oncologist for it at my first appt. of course it showed scar tissue, but nothing suspicious. he has since put me on a schedule for MRI and mammography once a year. His logic being that my original DCIS was not picked up by mammogram. I asked why I should have a mammogram at all, and he insisted that I get an annual mammogram. I don't know for how many years I will be getting MRI. I am being followed by a medical oncologist and radiologist, I haven't seen the BS since my surgical followup appt.

If I hear anything about no more post operative MRIs at my next radiologist appt, I will check in with you.

Take Care, I would bitch slap that BS for you if I could!

Julie E 

Hmmm.... MRIs are recommended for women who are high risk, and after a diagnosis of breast cancer, most of us are considered to be high risk to be diagnosed again. You would think that a personal history of breast cancer trumps a family history of breast cancer when it comes to assessing risk level, right?   To me, it's simple: an MRI should be part of the screening protocol for anyone previously diagnosed with BC and it should be covered by insurance. 

Add to that the fact that your earlier diagnosis of DCIS was better detected by an MRI than a mammogram and that should seal the deal, at least with your surgeon if not with your insurance company.

I don't get why your BS is saying that annual MRIs are not an appropriate follow-up.  Yes, an MRI will pick up scar tissue but anyone properly trained to read an MRI will be able to identify that.  I had a single mastectomy but get annual MRIs on my remaining breast.  I've had two excisional biopsies on this breast (so there's lots of scar tissue) and two needle biopsies.  I have a small stable benign cyst in that breast (which the MRI always identifies), and benign calcifications (which were biopsied previously).  Despite all that, I've had no problems with the MRI showing false positives.

I do think that the reason why breast cancer patients aren't on the list for annual MRIs is simply because not enough research has been done on this yet.  The MRI studies have been done on high risk women, women who have strong family history of BC or who are BRCA positive.  The studies have not yet been done (or completed) on women who have a previous history of BC.  So despite the fact that we are considered to be high risk, we don't meet the specific criteria of the studies so we aren't on the list for annual MRIs.

As for what's been presented at the San Antonio conference, while there were discussions over the weekend about screening, I haven't found any write ups yet.  Dr. Love's blog only goes as far as Friday's presentation and there is nothing about MRIs there.  In previous years, there have been presentations about the benefit of MRIs for high risk women; that's the info that I mentioned in my previous paragraph where those with a previous diagnosis of BC were not included in the studies so we aren't included in the recommendations for getting MRIs. Maybe that's what your BS is referring to. Here's this year's schedule:  http://www.sabcs.org/ProgramSchedule/ScheduleGlance.asp

And here is a recent study reported by BC.org that does start to talk to the issue of MRIs for women with a history of BC:

http://www.breastcancer.org/symptoms/testing/new_research/20101129.jsp "Women who've been diagnosed and successfully treated for breast cancer are at risk for recurrence (the original breast cancer coming back). These women also have a higher-than-average risk of being diagnosed with a new, second breast cancer. Because of these risks, regular breast cancer screening is very important for women with a personal history of breast cancer. This study suggests that yearly screening with BOTH mammography and breast MRI (magnetic resonance imaging) might be better than only a yearly mammogram for women with a personal history of breast cancer." 

Another article about the same study:

ACS recommends annual MRI screening in women with family history ...    "Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

The American Cancer Society (ACS) guidelines currently recommend annual screening with breast MRI in women with a known gene mutation or with a strong family history indicating a lifetime risk of breast cancer greater than 20 percent. However, the guidelines say there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer themselves."

And some study results that support the use of MRIs for "high risk" women:

MRI vs. Mammography for High-Risk Women - National Cancer Institute  "Study 1 Results:  Each woman in the study was followed for about two years. During this time, researchers found invasive breast cancers or non-invasive tumors (such as ductal carcinoma in situ, or DCIS) in 40 of the women. Forty-six percent of the tumors were small (1 centimeter or less) and 77 percent were confined (localized) to the breast. While the clinical breast exam detected 16 percent of the tumors and mammography found 36 percent, MRI sensitivity was found to be 71 percent. MRI sensitivity was even more pronounced in cases of invasive cancer (spread beyond the layer of tissue in which it developed), with 20 percent found by CBE, 26 percent by mammography, and 83 percent by MRI.

Study 2 Results: The results so far suggest that MRI offers the greatest sensitivity - 96 percent - for correctly diagnosing breast cancer in this high-risk group. In contrast, the sensitivity rate for detecting breast cancer was 25 percent for CBE, 43 percent for mammography, and 47 percent for ultrasound. Unlike the Dutch trial (Study 1), this trial found that MRI actually resulted in fewer cases of false positives than the other forms of screening, leading the German researchers to suggest that MRI should replace mammography as a screening tool for high-risk women.

Study 3 Results: MRI was 100 percent sensitive for correctly detecting breast cancer - finding a tumor when there was one - but only 83 percent specific. That is, 17 percent of MRI's positive findings were false alarms. Researchers with this study concluded that MRI sensitivity is encouraging but that the high false-positive rate limits its use as a routine practice. "

Twiddle, to my understanding sweatyspice has multi-focal grade 3 DCIS with necrosis.  The risks that this type of DCIS might become invasive are very high - it in fact many experts would say that it's almost a certainty.  The only question is when.  Of course, if all the DCIS is removed then the problem is taken care of, but with multi-focal DCIS, it's never possible to really know for sure that all the DCIS has been removed. If a few errant cancer cells were left, and if they were not successfully killed off by radiation or Tamoxifen, that's when a recurrence happens.  With DCIS, on average about 50% of recurrences are invasive.  So I think sweatyspice's concerns, and her question about enhanced screening with an MRI, are very valid.  You do raise a really good point about "cancer phobia". Having been on this board for 5 years, I have seen a lot of women for whom the fear does become overwhelming and borders on phobia, but I don't think that wondering whether an annual MRI might be a good idea fits that definition, or in fact, comes anywhere near it.

All DCIS is not alike.  Small amounts of low grade DCIS might never become invasive (to your comment that "You already know that DCIS is not very likely to become invasive") but that is certainly not true of multi-focal high grade DCIS with necrosis. 

For anyone who's already had BC and who therefore is higher risk than average to be diagnosed again, I simply don't understand why so many in the medical community don't agree to enhanced screening, with the inclusion of annual MRIs.  It makes no sense to me.  If a family history of BC is enough to get most within the medical community (and insurance companies) to agree that MRIs are warranted, how in the world could a personal history of BC not be enough?  Adding MRIs to the annual screening of former BC patients is just prudent, if you ask me.

Before getting an mri everyone should read this blog at



http://blog.remakehealth.com/blog_Healthcare_Consumers-0/bid/6788/What-is-an-MRI-with-contrast-dye

What is Gadolinium?



This is an FDA approved contrast agent for MRI. Gadolinium, or gadodiamide, provides greater contrast between normal tissue and abnormal tissue in the brain and body. Gadolinium looks clear like water and is non-radioactive. After it is injected into a vein, Gadolinium accumulates in the abnormal tissue that may be affecting the body or head. Gadolinium causes these abnormal areas to become very bright (enhanced) on the MRI. This makes it very easy to see.

//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////



Gadolinium is a rare metal found in the earth. Gadolinium is atomic number 64 on the periodic table; which many of us studied in high school or college chemistry. It is a silvery metal that is “ferromagnetic” or strongly attracted by a magnetic, which makes it an ideal product to enhance MRI and MRA images. Gadolinium is a stable compound in dry air, but when exposed to moist air, it will tarnish and forms a loose “film” which falls off and exposes more of the surface area to oxidation. The gadolinium also reacts to water and will dissolve in dilute acid.

Besides being used as a contrast agent for MRI and MRA images, Gadolinium has a number of other uses. Gadolinium is used to make a component of our microwave ovens, it is used in a compound that makes phosphors for color television tubes and it is also used to make computer memory and compact discs. Gadolinium is also used in nuclear marine propulsion as a burnable poison. Gadolinium also has other unique metallurgic properties so that a very small amount of gadolinium can improve the workability and resistance of iron, chromium and other related alloys to oxidation and high temperatures. Today, the medical profession uses gadolinium regularly as an intravenous agent to enhance the images taken by MRI and MRA studies.

Because gadolinium is a highly toxic, when it is used as a medical contrast agent it is attached to another chemical called a “chelate.” A chelate is a compound that “holds” the gadolinium so that it is not toxic and the body can process the gadolinium and dispose of it through our natural waste filtration system, the kidneys. Under most circumstances, the gadolinium is simply passed out of the body through the kidneys in urine. However, in some individuals who have compromised kidney function, the kidneys cannot work efficiently to remove it and some of the gadolinium remains in the body causing potentially serious gadolinium side effects. The longer the gadolinium stays in the bloodstream, the more chelates lose their hold on the gadolinium and break off, allowing more of the toxic gadolinium to contaminate the bloodstream. As the blood circulates throughout the body, the gadolinium is deposited in the skin, tissue and numerous organs. Once the gadolinium has taken up residence in human tissue, there is no proven way to remove it.

Over the past years, physicians saw patients with renal failure who received toxic gadolinium develop a deadly disease, and now gadolinium has been linked with a serious disease called Nephrogenic Systemic Fibrosis (NSF) or Nephrogenic Fibrosing Dermopathy (NFD).
http://www.usrecallnews.com/2008/04/gadolinium-health-alert.html

Beesie, in the past it seemed as if the mri's were 15 minutes (in and out pretty fast). It could had been longer. Yesterday, I was there about an hour (30 minutes actually in the tube). I've always had the IV so I know I've had the contrast dye, but never noticed it going into my arm, or throughout my body like yesterday. Before I had them done at an imaging Health Center, and the one yesterday at the hospital.



This morning I got a call, and was told that they want me to do the mri all over! I said to them that I preferred not to ... unless they saw something suspicious. The woman who did the mri said she would call the person who reads the mri and would get back to me. YUK! I don't like the idea of getting two mri's so close together. Right now, I'm not sure about mri's.



One thing about mammograms is that they only radiate the breast, where the mri contrast dyes go throughout your body...I think.

If one is so inclined, they could find a conspiracy theory hiding behind every medication, treatment, or medical substance available out there in the big mysterious internet.

As usual, the personal risks must be weighed against the potential benefits of any treatment.  To put this MRI-gadolinium risk into perspective, rational thought and scientific evidence-based facts are needed.

Per the FDA Drug Safety Newletter (link HERE) , "...a retrospective study with Omniscan in about 370 patients with severe renal insufficiency estimated the risk of NSF to be 4%"

That's 4% of a very specific subset of patients with "severe renal insufficiency or renal dysfunction due to the hepato-renal syndrome or in the perioperative liver transplantation period."

So *of course* there's some level of risk involved with contrast MRI, and maybe even some as-yet-unidentified risk, but to run around like chickens with our heads cut off worried about NSF from a breast screening MRI seems a bit bizarre. 

Skip the MRI if you feel uncomfortable, or discuss it with your medical team, but please get the facts before panicking.

From what I've read mri's are better at detecting dcis. After each of my dcis dx, the BS ordered a mri or a gadolinium type of mammo. Then I had two annual mri's...one yesterday.



After positive biopsies, my doctors order mri's. The BS showed me the mri pictures. The DCIS lesion lighted up like Christmas lights on the mri. She said the mri picture gave her a better look at what was going on in my breast. To add...the mammo, nor did the mri picked up the multifocal high grade dcis.



Mammo's maybe ok for dcis followup. The mammo's did pick up both dcis califications.

Because I am doing the "careful watch approach" (I did not do conventional treatment), I need to be vigilent. I can't forget that I'm at higher risk for a recurrence. I am also high risk due to dense breast, a lot of scar tissue, fungal infections, and I have very lumpy breast. This is why I've sought out alternative approaches to stay cancer free.



Yes, I'm nervous about putting toxic metals into my body. Cancer makes me a little nervous as well and even more the thought of cancer treatments. Knowledge and understanding makes me feel more in control and gives me peace of mind. I am not panicking about the mri...but needless to say concerned.

Since I know the rad doc is calling tomorrow in hope to talk me into repeating the mri, I'm doing a little more homework. I'm concerned about doing another mri right now, and concerned if I don't. Would any of you feel nervous about having the dye put into your veins within a weeks time?



http://www.oncolink.org/resources/article.cfm?c=3&s=8&ss=23&Year=2007&Month=6&id=14254



MRI spots high-grade DCIS more often than mammography: study



"High-grade DCIS is important to diagnose because it is easily curable with resection," noted Dr. Kuhl, vice chairman and professor of radiology at the University of Bonn, Germany. "If left untreated, it will progress to high-grade invasive cancer."



Dr. Kuhl and colleagues investigated the sensitivities of high-resolution MRI and state-of-the-art mammography for diagnosing DCIS. Among more than 5,000 women in the study, 167 were finally diagnosed with DCIS.



MRI was positive in 153 of 167 of these women (92%) while mammography was positive in only 93 of 167 (56%). "This difference is statistically significant at a very high level," Dr. Kuhl said.



MRI identified 98% of high-grade DCIS whereas mammography identified only 52% of high-grade DCIS. MRI identified 85% of non-high-grade DCIS and mammography spotted 61% of non-high grade DCIS.



"Mammography was less sensitive for high-grade versus non-high-grade DCIS," Dr. Kuhl pointed out.

I think it's reasonable too.  If we've been diagnosed with BC one time, why wouldn't we want to have the best screening we can to ensure that if we are diagnosed again, it's caught early? That's not crazy, that's not phobic, it's sane. The medical community seems to embrace this logic for women who are high risk but who've not yet been diagnosed. Why are they so reluctant to apply the same logic to those of us who've already had BC?

I was lurking on the thread as I have IDC not DCIS.  I wanted to see what you guys said about MRI's.  I have had microcalcifications for almost 14 years.  At the time they were discovered they were considered Atypical Hyperplasia but my BS recommended a lumpectomy at the time to remove it.  I have had yearly mammo's since then and have been called back on several occasion for more views but nothing at that point.  In July of this year I was called back on my mammo's and then told to have a biopsy.  Have moved since my last surgery so found another surgeon that specializes in breast disease.  We tried doing an excisional biopsy and was unsuccessful because they could not get the mammo's to line up horizontal and vertical with the wire.  I have so many calcifications.  Anyway my BS gave me some options and one was to have an MRI to basically rule out DCIS because she and the radiologist really did not think the calcificatons were cancer.  So I choose the MRi and when it was done I had IDC under my old scar tissue that never showed on any of my mammo's over the last 13 years.  My BS had several radiologist relook at all my mammo's over the years to make sure if anything had been overlooked.  As it turns out I did not know until now that I also have very dense breast tissue.  So thankfully it was stage 1.  My BS said at this point there was no way to tell if it started out as DCIS or how long it had been there.  It was very close to my chest wall.  I had a lump and am currently doing radiation.  My BS says that my follow ups will include MRI's because of my breast dense tissue and the scar tissue that I have that was hidding the tumor that I had. I will alternate mammo's and MRI's every three months for a couple of years.  I am fine with that.  The dye did not bother me.  I could tell when it was going in as it was a little cold in my vains. 

I think that the combination of a mammo, and ultrasound and an MRI presents the best possible picture of what might be going on.  But if I had to pick just one, I'd pick an MRI.  Next would be a mammo and then an ultrasound.  But that's just my impression in terms of their effectiveness.  The fact is that ultrasound show some things very well - better than mammos.  So adding an ultrasound to the MRI that was already done can't hurt.  

Deirdre, yes, I'm doing the watchful waiting. I've struggled over the decision to do the mri over.
I know you are a advocate for mri's as it probably does give the clearest picture. But, don't you think having the constrast dye twice so close together puts you at risk for renal problems? I am uncomfortable putting toxins in my body....and yet, I'm uncomfortable missing an early dx of cancer. I want to be cautious and I'm not sure what's right for me.

,,,,


The problem with the mri I had last week is there was too much movement (breathing movement) and it was too difficult to read. However, they did pick up something suspicious in the left breast. The two previous dcis dx were in the right breast. I have a lot of scar tissue in the right breast and since my last pathology report was multifocal, I've been more concerned about the right breast.

I'm not that worried. It's probably a false positive. And if it is positive, hopefully it's nothing more than dcis and the good news about a left-breast lumpectomy...is my breast would finally be the same size.

I had the ultrasound today. It did show up something so the next step is a biopsy on January 5th. I highly doubt it is anything serious. The RN who works in the breast cancer rads said since I didn't do the recommended treatment for my dcis that I would need to continue the mri's every year. She recommended a double mx if the biopsy came up positive. For now it's a wait and see...

I just got a call from my b.s. about my biopsy results. First to say is that I do not regret my choices. The last two years has been a journey to coming to grips with what caused my body to go wrong. I'm just now getting it

So...the report is I do have invasive cancer in my left breast. The doctor is going to be out next week, and suggested I see her associate to talk through my dx. I said, I can wait until she gets back. I'm glad. It gives me time to process this information, and to research more into what I want to do.

Right now, I don't even know what grade it is or what kind it is.

I am trusting that God will give me wisdom in how to proceed from here.

E Barry