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Doctor Says Breast MRI Works Too Well

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Can imaging be too detailed?

That’s the argument made by Malcolm Kell, MD, consultant surgeon and senior lecturer at the Eccles Breast Screening Unit of University College Dublin in Dublin, Ireland. In an editorial published last week in the British Medical Journal, Dr. Kell argued against routine magnetic resonance mammography for early stage breast cancer because MRM picks up recurrences or extensions of tumors too tiny for other screening methods to detect.

“The use of this technology in early stage breast cancer may do more harm than good,” the editorial said. “There is no compelling evidence that this technique should be routinely used in newly diagnosed breast cancer.”

So why is a lot of knowledge a dangerous thing? Because, Dr. Kell said, detection of minuscule “occult carcinoma not seen with conventional imaging” can  lead to mastectomies or other aggressive treatments that may not be necessary. He cited a study of women with breast cancer who were being considered for nonsurgical treatment. Women who had MRM had a 6 percent increase in mastectomies compared to women who did not.

Even without mastectomy, he said, if women with breast cancer are treated appropriately, the rate of recurrence is very low. Determining the type of cancer in the first place—whether it is sensitive to hormones, for example—is much more important for determining the prognosis than whether a residual amount of cancer that can be detected only by MRM is present, he contended.

Dr. Kell suggested that early stage breast cancer is best managed through yearly monitoring by conventional imaging and by drug treatment and radiotherapy where necessary.

In essence, Dr. Kell blames the messenger. MRM isn’t responsible for what use doctors and patients make of the information it provides. And if it were your breast, you might want to know as much as possible about any cancerous cells lurking inside it.

On the other hand, pressure to reduce health-care expenses by cutting out “unnecessary” procedures will certainly continue to mount. If MRM cannot be shown to improve patient outcomes, then justifying its use won’t be easy.

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

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