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MRI Before Breast Cancer Surgery Leads to More Dire Treatments

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According to a study published in the journal Breast Cancer Research and Treatment, older women diagnosed with breast cancer are undergoing preoperative MRIs more frequently, which is resulting in a higher rate of bilateral cancer diagnoses and more invasive surgical procedures.

Researchers from the Yale University of Medicine carried out a study to determine certain tendencies in MRI using age and type of surgery as preliminary blueprints.

“Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit of the more aggressive option,” said lead author and associate professor of internal medicine at Yale Cancer Center, Cary Gross, MD.

The researchers re-assessed the files of 72,461 women aged 67 to 94, who were diagnosed with breast cancer between 2000 and 2009. All were Medicare beneficiaries. Information was obtained and based on:

•  Association between MRI and surgical approach;

•  Breast-conserving surgery (BCS) versus mastectomy;

•  Bilateral versus unilateral mastectomy; and

•  Use of contralateral prophylactic mastectomy.

The findings reveal that 10.1 percent of the group received breast MRI and preoperative MRIs increased from 0.8 percent in 2000 to 2001 to 25.2 percent in 2008 to 2009. Researchers discovered that women who were administered an MRI were more likely to consequently undergo more aggressive surgical treatment.

Among the women who had mastectomies, having received a preoperative MRI was notably linked with an increased probability of being diagnosed with bilateral cancer (9.7 percent) as opposed to women who did not undergo an MRI (3.7 percent). Women who received the MRIs were also more likely to have bilateral mastectomy (12.5 percent) as opposed to women who did not have an MRI (4.1 percent).

Furtehrmore, women who were administered MRIs were more likely to have a prophylactic mastectomy of the unaffected breast (6.9 percent) as opposed to women who did not have MRIs (1.8 percent).

"There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age. Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer,” said assistant professor of surgery at Yale and first author on the study, Brigid Killelea, MD.

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