MRI May Be Counterproductive for Early Breast Cancer

A new review questions the clinical benefit of using MRI before surgery to assess the extent of early breast cancer. The authors say MRI has not been shown to improve surgical planning, reduce follow-up surgery, or reduce the risk of local recurrences. Nehmat Houssami, MBBS, PhD, of the University of Sydney, Australia, and Daniel F. Hayes, MD, director of the breast oncology program at the University of Michigan Comprehensive Cancer Center, reviewed available data on preoperative MRI’s detection capability and its impact on treatment. After reviewing the data, they concluded that there is evidence that MRI changes surgical management, generally from breast conservation to more radical surgery, but that there is no evidence that it improves surgical treatment or outcomes. The review appears online in CA: A Cancer Journal for Clinicians.
 
“Overall, there is growing evidence that MRI does not improve surgical care, and it could be argued that it has a potentially harmful effect,” the authors write.
 
Randomized controlled trials have shown that women with early stage breast cancer who are treated with breast conservation therapy (lumpectomy followed by radiation) have the same survival rates as those who undergo mastectomy. Recently, MRI has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional areas of cancer that do not show up on conventional imaging. The use of preoperative MRI scans in women with early stage breast cancer has been based on assumptions that MRI’s detection capability in this setting will improve surgical treatment by improving surgical planning, potentially leading to a reduction in re-excision surgery, and guiding surgeons to remove additional disease detected by MRI, potentially reducing recurrence in the treated breast. The authors say emerging data show that this approach to local staging of the breast leads to more women being treated with mastectomy without evidence of improvement in surgical outcomes or long-term prognosis. They say well-designed, randomized controlled trials are needed to quantify potential benefit and harm, including careful evaluation of its impact on quality of life.
 
“We acknowledge that logistics and costs of conducting such large-scale, multicenter trials are enormous,’ the authors write. “If the technology is truly as beneficial as its proponents claim, then these costs are worth it. If it is not, then they are outweighed by the costs of adopting expensive technology and associated intervention without evidence of clinical benefit.”
 
— Source: University of Michigan Health System