A new review says using magnetic resonance imaging (MRI) before surgery to assess the extent of early breast cancer has not been shown to improve surgical planning, reduce follow-up surgery, or reduce the risk of local recurrences.
The review, appearing early online in CA: A Cancer Journal for Clinicians, says evidence shows that MRI increases the chances of more extensive surgery over conservative approaches, with no evidence that it improves surgical care or prognosis.
Randomized controlled trials have shown women with early stage breast cancer who are treated with breast-conservation therapy (local excision and radiotherapy) 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. In the current review, Nehmat Houssami, MBBS, Ph.D., of the University of Sydney, Australia, and Daniel F. Hayes, M.D., of University of Michigan Comprehensive Cancer Center, Ann Arbor, Mich., reviewed available data on preoperative MRI's detection capability and its impact on treatment. 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 by guiding surgeons to remove additional disease detected by MRI and 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.