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3T MRI is the best MRI you can get to do Breast MRI. Most of the recent paper articles have shown a marked improvement in sensitivity and specificity of breast MR when 3T is used. A few links will be provided on the *links* page. But here is a summary of the new guidelines from the latest issue of the ACS journal CA: A Cancer Journal for Clinicians. It recommends MRI screening in addition to mammograms for women who meet at least one of the following conditions:
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- they have a BRCA1 or BRCA2 mutation
- they have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
- their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
- they had radiation to the chest between the ages of 10 and 30
- they have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative
- if they have two first degree relatives with breast cancer.
The recommendations are based on studies that were published after the ACS last revised its breast cancer early detection guidelines in 2002-2003. At that time, the panel concluded there was not enough evidence to recommend for or against MRI in high-risk women, so the guideline advised these women to make the decision after talking with their doctor. Now there is more solid evidence that MRI is useful for certain women.
"These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than using mammography alone," says Russell, co-director of the University of Southern California/Norris Cancer Hospital Lee Breast Center.
More to Be Learned for Other High-Risk Situations
For some women, however, the jury is still out on whether MRI screening is beneficial, even though they have conditions that do give them a higher-than-average risk of breast cancer. The new (2007) guideline says there still isn't enough evidence to recommend for or against MRI screening in women who:
- have a 15%-20% lifetime risk of breast cancer, based on one of several accepted risk assessment tools that look at family history and other factors
- have lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
- have atypical ductal hyperplasia (ADH)
- have very dense breasts or unevenly dense breasts (when viewed on a mammogram)
- have had ovarian cancer (either in the patient or a family history of this)
- have already had breast cancer - including ductal carcinoma in situ (DCIS)
However late in August 2007 Dr. Kuhl from Germany who uses a combination of 1.5T and 3T breast MRI published a landmark paper in the use of breast MR for evaluation of DCIS. They show very high sensitivity and specificity for DCIS and in fact breast MR is the premier modality - the gold standard for DCIS. This should be taken into account. This changes everything. But your surgeon may not know this. Some surgeons surprisingly say that they do not like breast MRI because it is too sensitive. This is not true. Nothing is too sensitive.
And don' you as a patient want to see everything. The issue is when you see something do you act on it immediately or can you wait 4-6 months to repeat the study. I generally say that in cases where I am not certain repeating the test in 6 months is the simplest and easiest way to be certain.
Breast MR at 3T really is better! (in 2009 the paper from the University of Toledo also showed that 3T MRI was 100% sensitive.) Also please demand that your physicians use Prohance. It is the most stable contrast and has never been (by itself) associated with NSF. All of the other contrasts have several hundred associated cases of NSF.
Remember at 3T MRI consultants we have a stronger 3T magnet and more experience. We give you the results immediately because we aways have a doctor present for your scans. We care about the patients. I think if you ask - you will NOT be able to discuss your results with the MR physician at most facilities immediately after the scan. We care about our patients. Some other facilities now offer 3T but we have been offering this technology since 2007
We use Prohance (tm) contrast because we care. We have a physician who will give you results immediately because we care.