MRI Aids Cancer Detection in the Opposite Breast of Women Newly Diagnosed with Breast Cancer

>	Research conducted at 25 institutions across the country, including the Abramson Cancer Center of the University of Pennsylvania, found the addition of an MRI scan led to the detection of more than 90 percent of cancers in the opposite breast missed by mammography and clinical breast exam, increasing the number of cancers detected.
>	Researchers are also optimistic that MRI may lead to long term savings to patients and to the health care system. The fact that MRI can detect most cancers in both breasts prior to therapy may result in fewer rounds of chemotherapy and fewer breast surgeries.
>	The study was published in the March 29th, 2007 issue of the New England Journal of Medicine

(PHILADELPHIA) – One in every 10 women newly diagnosed with cancer in one breast will also develop the disease in the opposite breast. These opposite – or contralateral – breast cancers often take years to diagnose, which can increase patient anxiety, lower the chance of successful treatment, and lead to additional procedures.

A study conducted by the American College of Radiology Imaging Network (ACRIN) study published in the March 29th, 2007 issue of the New England Journal of Medicine helps establish magnetic resonance imaging (MRI) as a key component of the diagnostic workup for women at the time of initial breast cancer diagnosis.  The research, conducted at 25 institutions across the country, including the Abramson Cancer Center of the University of Pennsylvania, found the addition of an MRI scan led to the detection of more than 90 percent of cancers in the opposite breast missed by mammography and clinical breast exam, increasing the number of cancers detected. 

“I think MRI is a very good option,” said Mitch Schnall, MD, PhD, Matthew J. Wilson Professor of Radiology and senior author of the study. “It can provide peace of mind for women when they’re diagnosed. This study clearly shows that one in 30 women who think they have cancer in one breast after a traditional evaluation with mammography and clinical exam, actually have bilateral breast cancer that can be detected by MRI. Knowing this at the time of diagnosis of the first cancer has a significant impact on the approach to treatment.”

Supported by the National Cancer Institute (NCI), the ACRIN trial recruited 1,007 women across 25 sites, including Penn, who had a recent diagnosis in one breast and found that the added benefit of MRI was consistent – regardless of cancer type, age, and breast density.  Also, the diversity of medical facilities participating in the trial that recruited patients – from academic institutions, community hospitals, and imaging centers – suggests that the results can be generalized to other practices. 

In this study the MRI scan detected a variety of cancer types.  In general, those cancers were at an earlier stage than cancers found in other types of exams, which is important because breast cancers detected at an earlier stage are often more treatable.  

Researchers expect that if a MRI of the opposite breast is negative, women diagnosed with cancer in only one breast can more confidently opt against having a double mastectomy.  “Although no imaging tool is perfect, if the MRI is negative, the chance of cancer in that breast is extremely low.  A potential outcome that we would be delighted to see is fewer unnecessary bilateral mastectomies and fewer recurrences years after the initial cancer diagnosis," said Constance Lehman, MD, PhD, principal investigator of the ACRIN breast MRI trial, and Director of Breast Imaging at the University of Washington and Seattle Cancer Care Alliance.  The ACRIN trial also noted fewer “false positives,” or initial findings that later proved not to be cancer, than previous, smaller breast MRI studies had documented. 

According to the NCI, in the United States breast cancer is the most commonly newly diagnosed non-skin cancer in women, and the second leading cause of cancer-related death in women. In the United States in 2007, an estimated 178,480 women will be diagnosed with breast cancer, and an estimated 40,460 women will die of the disease. 

Researchers are also optimistic that MRI may lead to long term savings to patients and to the health care system. The fact that MRI can detect most cancers in both breasts prior to therapy may result in fewer rounds of chemotherapy and fewer breast surgeries. According to Schnall, “This study certainly points to future trials need for another, multi-center study that clearly demonstrates the ability of MRI to detect cancer not seen by mammography. Hopefully, this will lead to recommendations from the American Cancer Society for all women who fall into high risk categories for breast cancer to add MRI screenings to the arsenal in the fight against cancer."

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