MRI Results Prompting More Mastectomies, Study Finds

CHICAGO _ Signaling the reversal of a long decline in the use of mastectomy for breast cancer patients, a new study indicates more women are opting for the operation in part because more patients are getting MRI scans that can find additional tumors.

The marked change in care in recent years suggests a deepening of the emotional dilemma that many women face when choosing between mastectomy and more targeted treatments that can preserve the breast.

The study of 5,463 Mayo Clinic breast cancer patients found an increase of 13 percentage points in the use of mastectomy between 2003 and 2006. That rise coincided with a doubling in the use of MRI for such patients, according to the report, which was released Thursday in connection with an American Society of Clinical Oncology meeting to be held in Chicago later this month.

The rebound in mastectomy rates is sparking a debate among oncologists about whether the enhanced sensitivity of MRI, or magnetic resonance imaging, is always a good thing.

Many studies have found MRI can locate breast tumors that ordinary mammography would miss, and that often leads to more aggressive treatment, including mastectomy. Yet no one knows if the mastectomies spurred by MRI findings are actually improving patient outcomes.

In some cases, the additional tumors that MRI reveals might be effectively treated with more limited therapies, such as removing the initial lump followed by radiation and hormone treatment, said Dr. Seema Khan, director of the program for early detection and prevention of breast cancer at Northwestern Memorial Hospital. But once a scan uncovers additional tumors, many patients instinctively opt for a full mastectomy.

“There’s a huge question of whether we’re being led down a path of overtreatment by routinely using MRI,” said Khan, who was not part of the Mayo research team.

No one questions the usefulness of MRI for certain high-risk groups of patients, including young women with especially dense breast tissue that other imaging techniques cannot see through. Experts also recommend MRI scans for women with genes such as BRCA1 and BRCA2, which increase the risk of breast cancer.

Many doctors value the increased accuracy of MRI and use it to determine the best surgical option for a tumor detected by a mammogram.

Having a breast MRI helped Nicole Bokich of Burr Ridge, Ill., decide last year to have a double mastectomy. The scan detected an additional growth of a type that is linked with an increased risk of having more tumors in the future.

“I personally wanted to know everything, have every test possible, and make a completely informed decision,” said Bokich, 41, a stay-at-home mom with three kids.

Bokich said she could have decided to remove just the tumors but felt a mastectomy would decrease the chance of any future recurrence.

“It truly is such a personal decision,” Bokich said. “I’m perfectly happy with the decision I made for myself.”

Mastectomy rates declined steadily through the 1990s as more patients got lumpectomies, or removal of the cancerous lump followed by radiation treatment. The switch was driven by studies finding the odds of surviving small, early-stage tumors were the same for both procedures.

Yet patients with multiple tumors or larger growths often choose mastectomies to prevent recurrence. MRI may help those patients base their choice on more solid evidence, said Dr. Matthew Goetz, a Mayo Clinic oncologist who led the study presented Thursday.

“The fact that mastectomies are going up now may suggest that the numbers had been too low,” Goetz said. “We really don’t know what the optimal rate is.”

Some experts hope new advances in imaging technology will help doctors see which tumors revealed by MRI are serious enough to warrant more aggressive treatment, and which ones are unlikely ever to become dangerous.

“For a large number of breast cancers, we don’t know which ones are eventually going to kill the patients and which ones could potentially be left alone,” said Dr. Davide Bova, a professor of radiology with Loyola University Health System.

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