MRI Better Than Mammogram?

[PAH]

My sister was recently diagnosed with breast cancer.  Her surgeon removed a 6.5cm. tumor from her right breast and her lymph nodes were subsequently determined to be negative.  Shejust completed her first chemo treatment and when the chemo is complete, she will have radiation treatments. My question is this:  What is the best imaging technique to use for very large, dense breasts?  Her oncologist stated that this tumor has been growing for many years, yet with yearly mammograms it went undetected until now.  I have read that there are many newer imaging techniques that are better than a mammogram for women with dense breats.  Which imaging modality should we request for her now and in the future for routine follow-ups.  We asked her oncologist this question and he stated that she should undergo routine mammograms and sonograms.  Please help. From everything I've read, those tests are not the best for her circumstance, yet I can't find anything that says which test is best.  Is it MRI, PET, Scintimammagraphy or something else?  We are not going to have any peace of mind until we can feel confident that they have identified all the cancer she may now have.  I also have a question about chemo drugs.  Is CAF better than a combination of CA and Taxol?  Sorry for the long question, but her doctor was not very helpful.

[pammie2001]

I just finished my last cycle with Roswell.  They are doing a study (have been) on MRI versus Mammograms.

This was for HIGH RISK women.  You go in, have a Dr. examin your breasts, then have a mommogram, then have a MRI of each breast.

There has been PROOF that even there at Roswell, Breast Cancer has been FOUND after the exam and mammogram being negative.

It is a big money game with insurances to pay for MRI's, but YES, MRI's DO detect more than a mammogram.

Down side for some is:  MRI can not determine wether these are cancer, so more biopsy's would be done.

For me, I say I do not mind the extra biopsy, you just never know.

With this study there were women that HAVE Breast Cancer and was not diagnosed in self exam, Dr. Exam or mammogram.

[CCF-RN,MSN-JS]

Dear Jacci, Please excuse the delayed response to your question.  Currently mammograms are still the most effective screening tool we have for early detection of breast cancers.  The technology of the procedure continues to be refined, better equipment, less radiation dose.  To date there are no perfect tests, and every test has its own limitations.  For instance, neither MRI or PET scan have shown to be good at detecting very small early cancers.  Research continues as to where these tests will be best utilized in the continuum of breast cancer care.  

In regards to the chemotherapy question, the data at this time is not available as to whether CA + taxol will have an advantage over CAF.  CAF is the current standard of care for adjuvant treatment for Breast cancer.  CA + taxol is being evaluated in clinical trials to see whether there will be an overall advantage in terms of survival.  

[healthcareguerilla]

I don't know if I'd say that the mammogram didn't do a good job in your sister's case. It did, in fact, find the anomaly. In my case, nothing was seen via mammography, and yet, the aspiration biopsy showed malignant cells. Excisional biopsy showed a mess, including DCIS and LCIS, but not malignant cells. Self-breast exam, and knowing your own breasts thoroughly, remain the best means of evaluation, but, as you note, size and can make this difficult, especially if when we examine our breasts we perform the exam with terror. We need to "make friends" with our breasts, and not see them as potential enemies. What concerns me too, is that with the emphasis on breast cancer, we can almost ignore our general health, and, once breasts are diagnosed as having disease, that it's all the more difficult to get medical practitioners to pay attention to our whole selves. One can indeed pose the question, "If more men got breast cancer, would there be better resources?" (As an aside, the first person I saw with a suspicious breast lump was a man). But I wonder if posing this question does any good. Women must make their voices heard by those funding research. While the various marches, runs, etc. may be good for the soul, the "pink ribbon" attitude, as I am wont to call it, alludes to passivity when what we need is war on breast cancer. Of course, this gets problematic because must then insist that the milk which we pour on our cereal, packaged, in one case, in that pink ribbon, for God's sake, not be teeming with antibiotics and other chemicals known to diminish our immune systems. It means taking responsibility and not using all manner of cleaning chemicals in our households so that they will smell good and we can present ourselves to the world as diligent housekeepers. Just look at chlorine; one of the most toxic substances on the planet and, by God!, we've got to have those whiter-than-whites! (What IS whiter than white, anyway? And how white do we need to be?) Starting with myself, it is past time to be silent and "good". We've got to go for a cure at whatever the cost. And, we need to be loud and united in this effort. Blessings to you.

[healthcareguerilla]

I empathize with what you're all going through. I guess I'm adding to your question more than offering any help. Yes. When will we have more definitive tests available? And, is there any way to take random cell samples on a previously diagnosed or pre-cancerous diagnosed breast without risking the spread of abnormal cells? Because it seems to me that unless one examines cellular structure, it comes down to an educated guess. I would like to know how your sister's breast cancer was found, and what the initial pathology report showed. From what you describe, the cancerous cells were removed and there was not evidence of metastases (the negative lymph nodes). But absolute assurance that there won't be a future event is impossible to determine for all of us and I think it is the most difficult to address. The sense of being out of control can be overwhelming and we need to do whatever works for us (while listening very, very carefully to those gut feelings that tell us if something is good or bad for us), to ease the anxiety. I would urge you to respect your sister's feelings and approach to dealing with the issue of cancer. She'll find her way. And you must find yours. I'm still working on mine. For me, it's rather existential, which gets rather tiresome, so, sometimes, I just stop trying to figure it all out and live.

[PAH]

Thanks for your comment.  My sister's cancer was initially discovered during a routine mammogram by the technician.  The cancer had grown to roughly the size of a golf ball, but due to the location of the cancer and the size of the breast, it was difficult to detect manually.  She was diagnosed with Ductal Carcinoma In Situ/Invasive.  Estrogen/progesterone negative, positive for HER-2. My sister and I are concerned with the fact that it was not picked up on mammogram at a much earlier stage. We cannot be minimally confident that there are no other tumors as yet undiscovered.  Additionally, she will need on-going surveillance from here on out. We need a test that is more realiable than the mammogram has proven to be. Don't get me wrong, I am not saying that the mammogram is no good in general.  It's just that in her particular case, it doesn't do a good job because of the denseness of her breasts.  I realize that I have a hard time being objective when it comes to my sister, but I have to wonder if breast cancer was a man's disease, would they have better treatments available by now?  I wish you continued good health.  Take care and God bless.
Jacci