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MRI for breast cancer raises odds of surgery

YALE (US) — For older women with breast cancer, heavy use of MRIs may lead to unnecessary breast removal surgeries.

“These data are concerning because the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear,” says the study’s lead author Cary Gross, associate professor of internal medicine at Yale University School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale Cancer Center.

“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,” Gross adds.

The research team tracked the use of breast MRI and surgical care of 72,461 female Medicare beneficiaries age 67-94 who were diagnosed with breast cancer during 2000 to 2009.

The team found a considerable increase in the use of preoperative breast MRI over the study period—from 1 percent in 2000-2001 to 25 percent in 2008-2009. The researchers also found that women who received an MRI were more likely to subsequently undergo more aggressive surgical treatment.

In women who received mastectomy, 12.5 percent of those who had MRI received bilateral mastectomy, while only 4.1 percent of those who did not have MRI had bilateral mastectomy.

The study also reveals that women undergoing MRI were more likely to have a contralateral prophylactic mastectomy (surgery to remove both breasts when cancer was only found in one breast). Among women who underwent mastectomy, 6.9 percent of women who had an MRI underwent contralateral prophylactic mastectomy, compared to 1.8 percent in women who did not have an MRI.

“There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age,” says first author Brigid Killelea, assistant professor of surgery.

“Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer.”

The National Cancer Institute and the P30 Cancer Center Support Grant at the Yale Comprehensive Cancer Center supported the research, which appears in Breast Cancer Research and Treatment.

Source: Yale University

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