The every 6 month monitoring for high risk women like me

I think many of us with high risk condition are monitored every 6 months, having annual mammogram alternating with annual MRI. Another potential option is PBMX, if the surgeon is supportive of that.

I am 37, have had 3 breast biopsies with fairly widespread ADH and other type of atypia found in biopsy samples in 2007-2009. Lifetime risk of 40% to have breast cancer based on Gail Model. Extremely dense breast tissue. I have been coming to this forum on and off since 2009, and have been absorbing wisdom from all the ladies here so much...

The more I read, the more I feel my question is trivial. I have been wondering whether having IV contrast/Gadolinium with breast MRI is harmful. Whether annual mammo with biannual breast MRI is "good enough"? I understand nephrogenic systemic fibrosis has only be shown in patients with kidney disease who had the MRI contrast. There is some discussion that gadolinium has been found in patients' brain for those who have normal kidney function and more than 4 times of MRI. There is no data about the significance of finding gadolinium in the brain, however, it is toxic once it is separated from its ligand which is connected to stabilize it. In patients with kidney disease, it takes longer to excrete it, therefore higher chance for it to get separated from its ligand.

With that said, studies have been showing that mammogram has only about 44% sensitivity in detecting early breast cancer in dense breasts, while MRI can improve the sensitivity to about 80%.

"Findings from our large prospective study of screening mammography, PE, and US show that sensitivity and specificity of screening mammography are 78% and 99%, respectively. For invasive cancer, the mammographic sensitivity is 73.0% for all breast types, but in the most dense breasts, it is only 44%. The mammographic sensitivity in women 49 years and younger was significantly lower (58%) than that in older women (83%). " (http://pubs.rsna.org/doi/full/10.1148/radiol.22510...)

Therefore, I probably dare not to have annual mammogram only. I guess there is a reason that American Cancer Society recommends annual mammogram alternating with annual MRI for people with high risk profile. Maybe drinking tons of water after MRI is the only thing I can do about this situation - which I forgot this time :-P

Another choice is PBMX. As we all know, it is totally a personal choice and everyone makes up their mind differently. My concern is potential complications with surgery. I work in a hospital and see so many things could go wrong with any surgery, like MRSA infection etc. My impression to surgery is sort of biased. I am still thinking about it from time to time, of course. When I mentioned PBMX to my high risk oncologist, she felt that it is a little too aggressive. The plan is maybe having PBMX if I have another biopsy or something more than ADH showing up. Otherwise to continue the current plan with every 6 month monitoring and to start tamoxifen at the age of 45. I asked about starting it earlier at age 40, however, my oncologist feels that it may give me more benefit if I take it later at 45, IF I do not have breast cancer before that.

I remember last time when I came here, a very kind lady farmerlucy told me that, "don't let your mind carry you away to the worse case, it only robs today of its joy...."The sentence gave me a lot of warmth and courage. Thanks so much again.