“Breast cancer?”
I had a mammogram done on both breasts in February and repeated it in March and did a biopsy on my left breast at the end of March. I was diagnosed with breast cancer in the left breast (DCIS Stage 0). Did an MRI yesterday and now the surgeon wants me to do another mammogram. My daughter thought the MRI is more detailed than a mammogram. Why would they want me to another mammogram on the right breast after an MRI?
Female | 65 years old
4 Answers
Mammogram is good to detect DCIS which usually presents with micro calcification. MRI is good to detect tumor in very dense breast , not good for DCIS without tumor mass.
Good evening,
Often a staging MRI is performed after a new diagnosis of breast cancer. This is done to look at both breasts and see if there are any abnormal findings that could be other cancers in the breast with the known cancer and/or the other breast. This is also a good way to check the full extent of the known cancer. A small percentage of patients will have an additional cancer that is occult (not visible) on your mammogram. If there is an abnormal finding on a breast MRI, aside from the known cancer, radiologist may want to do special mammogram views and/or ultrasound to see if they can find the area and biopsy it. This is commonly referred to as a “second look” mammogram or ultrasound after an MRI. A percentage of these abnormal MRI findings are “false alarms” or false positives (not cancer).
You are correct- MRI with intravenous contrast/die is the most sensitive breast study (will detect the most cancers); but after an abnormal MRI, it is very common for “second look” mammograms and especially ultrasound to be recommended by the radiologist. If the abnormal area cannot be detected on the secondary mammogram or ultrasound, an MRI guided biopsy may be recommended, depending on the level of suspicion/concern.
There may be a finding on your recent MRI that the radiologist want to assess further and possibly obtain a biopsy of. This is not uncommon and does not mean you have an additional cancer.
In the case of a screening breast MRI for patients who have a high lifetime risk for developing breast cancer, it is still recommended that these women also continue to get annual screening mammograms, as there are some findings that may only be detected on a mammogram. Also, mammograms are still the only test that has been shown to decrease mortality related to breast cancer.
I hope that answers your question.
Often a staging MRI is performed after a new diagnosis of breast cancer. This is done to look at both breasts and see if there are any abnormal findings that could be other cancers in the breast with the known cancer and/or the other breast. This is also a good way to check the full extent of the known cancer. A small percentage of patients will have an additional cancer that is occult (not visible) on your mammogram. If there is an abnormal finding on a breast MRI, aside from the known cancer, radiologist may want to do special mammogram views and/or ultrasound to see if they can find the area and biopsy it. This is commonly referred to as a “second look” mammogram or ultrasound after an MRI. A percentage of these abnormal MRI findings are “false alarms” or false positives (not cancer).
You are correct- MRI with intravenous contrast/die is the most sensitive breast study (will detect the most cancers); but after an abnormal MRI, it is very common for “second look” mammograms and especially ultrasound to be recommended by the radiologist. If the abnormal area cannot be detected on the secondary mammogram or ultrasound, an MRI guided biopsy may be recommended, depending on the level of suspicion/concern.
There may be a finding on your recent MRI that the radiologist want to assess further and possibly obtain a biopsy of. This is not uncommon and does not mean you have an additional cancer.
In the case of a screening breast MRI for patients who have a high lifetime risk for developing breast cancer, it is still recommended that these women also continue to get annual screening mammograms, as there are some findings that may only be detected on a mammogram. Also, mammograms are still the only test that has been shown to decrease mortality related to breast cancer.
I hope that answers your question.
Hello.
The reasons for the treatment of breast cancer depend on the histology (cell type) of the cancer and the stage. DCIS (ductal carcinoma in situ) is an early cancer that has not spread beyond the area where it arose. However it is necessary to excise this lesion as it may become invasively malignant in the future.
X-rays including mammograms and MRI scans are clinically important in making decisions regarding recommendations for the best treatment. Mammograms are often recommended for screening asymptomatic women for early stage breast cancer.
Recently MRI scans have been compared with mammograms for evaluation of breast cancer. The studies suggest that MRI scans are as effective as mammograms in this evaluation.
An important study has been published. One can find this via a google search asking the question “MRI versus mammography in DCIS”. The reference is Jeeyan Lee et al, the efficacy of breast MRI versus mammography in surgical decision in patients with breast cancer: ductile carcinoma in situ and invasive ducal carcinoma BMC Cancer 2020 20:934. Other studies support these findings.
There must be a reason that the surgeon is asking for a repeat mammogram. It might be possible that the X-rays were reviewed by another radiologist and something was found in the other breast that wasn’t seen on the MRI scan. One needs to show this article to the surgeon and ask this question. There is likely a more complete explanation for this recommendation that is readily apparent.
The reasons for the treatment of breast cancer depend on the histology (cell type) of the cancer and the stage. DCIS (ductal carcinoma in situ) is an early cancer that has not spread beyond the area where it arose. However it is necessary to excise this lesion as it may become invasively malignant in the future.
X-rays including mammograms and MRI scans are clinically important in making decisions regarding recommendations for the best treatment. Mammograms are often recommended for screening asymptomatic women for early stage breast cancer.
Recently MRI scans have been compared with mammograms for evaluation of breast cancer. The studies suggest that MRI scans are as effective as mammograms in this evaluation.
An important study has been published. One can find this via a google search asking the question “MRI versus mammography in DCIS”. The reference is Jeeyan Lee et al, the efficacy of breast MRI versus mammography in surgical decision in patients with breast cancer: ductile carcinoma in situ and invasive ducal carcinoma BMC Cancer 2020 20:934. Other studies support these findings.
There must be a reason that the surgeon is asking for a repeat mammogram. It might be possible that the X-rays were reviewed by another radiologist and something was found in the other breast that wasn’t seen on the MRI scan. One needs to show this article to the surgeon and ask this question. There is likely a more complete explanation for this recommendation that is readily apparent.
It is hard to tell for sure why the surgeon would want another mammogram. It is not necessarily that the MRI is more detailed than a mammogram, it is that they simply give slightly different types of information. The most likely situation is that something was seen on the MRI for which they want to get clarification with a mammogram and or on ultrasound. I think her best course of action would be to talk to the surgeon and find out why he or she feels that a mammogram is needed.
