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June 28, 2011 > Breast MRI Aids Diagnosis and Treatment of Breast Cancer

Breast MRI Aids Diagnosis and Treatment of Breast Cancer

Washington Hospital Radiologist Discusses the Benefits

Most women know that a mammogram can help to detect breast cancer early. But what about a breast MRI; when should you have one of those?

"While the mammogram is still the best screening tool we have for most women, an MRI is called for when we need more information than a mammogram can provide," said Dr. Sunil Upender, a radiologist at Washington Hospital who completed a fellowship in Breast Imaging at Yale University Medical Center. "It is recommended for women who are at high risk for developing breast cancer, especially those who have dense breasts."

An MRI (magnetic resonance imaging) is a noninvasive medical test that provides detailed pictures of the breast and surrounding tissue. These detailed images allow physicians to better evaluate what is happening inside the breast.

"Other tests, like mammograms and ultrasounds, tell us how something looks, whether it looks like cancer," Upender said. "But, an MRI tells us how something behaves. Cancer actually behaves differently than a benign mass, and we can see that with an MRI."

An MRI uses radio waves and strong magnets to create an image instead of x-rays. A type of dye is injected into the veins so physicians can clearly see any abnormalities in the breast.

"Cancer cells encourage blood vessels to grow around them," Upender explained. "These blood vessels look and act different. They are weak and chaotic. They don't behave like any other blood vessels."

Because physicians can actually see how cancer acts inside the breast, an MRI also serves as an important tool for helping physicians determine the extent of the cancer and the best treatment options.

"For example, sometimes we can only see something on a mammogram in one breast," Upender said. "But we know that when breast cancer is in one breast, 5 to10 percent of the time it is in the other breast. The MRI allows us to get a better look, determine what is really going on, and work with the patient to determine the best course of action based on what we are seeing."

According to Upender, one of the downsides with breast MRI is that it can be too sensitive, creating false positives. This can lead to unnecessary follow up. He said breast MRI is not a good screening tool for the average-risk patient.


Screening is Critical

While men can get breast cancer, it is much more common in women. In fact, breast cancer is the most common cancer among women and the second leading cause of cancer deaths among women, according to Upender. He said one in eight women will develop breast cancer in her lifetime.

"These numbers are astounding," he said. "That's why it is so critical for women to be screened with mammography."

Screening has been proven effective. Since the onset of regular mammography in 1990, the mortality rate from breast cancer, which had been unchanged during the preceding 50 years, has decreased by 30 percent, according to Upender.

A breast MRI should not be used in place of a mammogram, but instead can supplement it as a diagnostic tool, Upender said. Mammograms detect most cancers, but they do have some limitations.

"Mammograms compress the breast, so we are seeing everything superimposed, which makes it possible to miss something," he said. "That's why we recommend that women with high risk have an annual breast MRI in conjunction with mammography.

This is especially beneficial for women with very dense breast tissue."

The American Cancer Society recommends that anyone with greater than 20-25 percent lifetime risk for breast cancer should have a yearly mammogram and breast MRI. Those at higher risk include women with a strong family history of breast cancer, those with the BRCA gene, and possibly women who have had breast cancer before.

"There is a risk assessment tool your physician can use to determine your lifetime risk for breast cancer," Upender said. "It's important to work with your doctor to determine whether you are a candidate for a breast MRI."


Breast Health Services at Washington Women's Center

Washington Hospital created the Washington Women's Center to provide advanced diagnostic services and expert clinical staff to women, as well as support services and wellness programs. Washington Women's Center has been accredited by The National Accreditation Program for Breast Centers (NAPBC).

For information about breast health services offered by Washington Hospital, visit www.whhs.com/womenscenter or call (510) 608-1301 for more information.

To learn more about the Washington Outpatient Imaging Center, please visit www.whhs.com/imagingcenter

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