Additional Aggressive Cancers Can Be Found Using Breast MRI Following Mammography Screening

In younger women, and those with dense breasts, MRI can detect cancers that have two or more distinct primary tumors, often in different breast quadrants. Most of the so-called multicentric cancers were discovered in women with heterogeneously dense or very dense breasts, but cancer was also found in 19% of patients with fatty or scattered fibro-glandular tissue.

The researchers reviewed the records of 2,021 patients that had newly-diagnosed breast cancer, had preoperative MRI, and a biopsy. The MRI detected additional cancers that were not found in the mammography, in 14% (285) of the patients. In 25.6% (73) of the 285 patients the MRI revealed one or more additional cancers in a different breast quadrant than the index cancer, or that detected by breast palpation and/or mammography. In 17 of the 73 patients (23.3%) the multicentric cancers were larger than the known index cancer. The MRI scan also detected multicentric cancers larger than 1 cm in 25% of the 73 patients.

Lead author of the study, Chiara Iacconi, MD, Breast Unit, USL1 Massa-Carrara, (Carrara, Italy), said, “Patients with clinically insignificant cancers undergoing potential overtreatment versus patients who may be undertreated is at the heart of the controversy surrounding breast MRI. We believe invasive cancer larger than 1 centimeter is clinically relevant disease. In general, it is accepted that radiation can likely treat invasive cancer less than 1 centimeter, but lesions larger than 1 centimeter, especially invasive carcinomas, may not be reliably treated with conservation. The results show that multicentric cancer detected on breast MRI after mammography appears to represent a larger tumor burden in approximately a quarter of patients and can result in potential changes to cancer grade and treatment.

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USL1 Massa-Carrara