MRI as Effective Screening?
Posted 3/31/2011
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This is an important editorial from the Journal of Clinical Oncology. Examining the evidence, it concludes that annual breast MRI can be an effective screening for women who carry a gene (BRCA1 or BRCA2) mutation and who otherwise would have had prophylactic bilateral mastectomies. This has been an excrutiating choice for women. As we know, it is tough enough to lose a breast when there is cancer there. Making the choice to prospectively lose both breasts before there is cancer is really hard.
It is also reasonable to expect that this data will become important in the care of women who have had breast cancer. Even without a positive gene mutation, some women opt for bilateral mastectomies, feeling that removing their breasts is their only way to diminish future anxiety. Presumably, being reassured that annual breast MRIs are usually an equally protective choice will enable some women to avoid more surgery. There will always be women who can only be comfortable with mastectomies, but, fully understanding the data and the choices, will be empowering and helpful.
Below is the introduction along with a link to read more:
Is Screening With Magnetic Resonance Imaging in BRCA Mutation Carriers a Safe and Effective Alternative to Prophylactic Mastectomy?
Monika L. Burness, University of Chicago, Chicago, I LOlufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL
The discovery of the BRCA1 and BRCA2 genes in the early1990s, ushered in a new era for women at high risk for breast cancer; it is now possible with a simple diagnostic test to determine the presence or absence of deleterious mutations in these genes in an individual's genome. However, the psychological, social, and clinical implications of this finding, which predicts lifetime risks of 56% to 84%,are far from simple.
Anumberofprophylactic interventions exist that decrease breast cancer risk to varying degrees, but all have adverse effects. Prophylactic mastectomy is most effective at decreasing risk; the reported proportion ofwomen choosing this option varies greatly, by country of origin and whether affected or unaffected mutation carrier status. Chemoprevention with the selective estrogen receptor modulator tamoxifen can also decrease risk, but with adverse effects that include deep vein thrombosis and endometrial cancer. In addition, its effectiveness in unaffected mutation carriers is not well documented. Similarly, oophorectomy decreases breast and ovarian cancer risks but results in early menopause. For women at high risk for breast cancer who do not desire prophylactic mastectomy, an adequate screening modality is necessary to detect tumors at the earliest stage possible to give women the best chance of cure.
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