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Breast MRI: What all women should know

October 14, 2009 9:59 AM with Dr. Katharine Yao

Dr. Katharine Yao, Director of the Breast Surgery Program and Co-director of the new Center for Breast Health at Evanston Hospital, will discuss why breast MRI is important for some women.

Moderator (Moderator) - 9:56 AM:
Welcome! Today’s chat: Breast MRI—What All Women Should Know, will begin shortly. Please start submitting your questions and Dr. Katherine Yao will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Breast Cancer pages to obtain more information about Breast cancer and breast MRIs.

Dr. Katharine Yao (NorthShore) - 10:02 AM:
Welcome! I am the Director of the Breast Surgical Program at NorthShore University HealthSystem and I am here to answer your questions.

  Ann (Evanston, IL) - 10:03 AM:
I've thought about getting an MRI due to family history, but I am very claustrophobic. How long does it take and is there some medicine they could give me to calm my nerves?
Dr. Katharine Yao (NorthShore)
MRI has been approved by the American Cancer Society for screening high risk patients based on family history so you would be a candidate based on your family history. You can take some valium to relax you before the MRI which your primary doctor can prescribe. The test takes about one hour.

  Aynslee (Park Ridge) - 10:05 AM:
What should I do to prepare to for the MRI?
Dr. Katharine Yao (NorthShore)
You have to lie on your stomach for the MRI so patients with back problems sometimes cannot tolerate the MRI. You will also get an IV for contrast injection for the MRI. Otherwise there is no special preparation or special diet you have to be on.

  Mary (Niles, IL.) - 10:07 AM:
Is it "overkill" to do annual MRI scans for someone with a history of LCIS?
Dr. Katharine Yao (NorthShore)
The screening guidelines for MRI do not specify whether patients with LCIS should get a MRI. We just don't have enough data on this patient population. If your lifetime risk is greater then 20% than you are a candidate for annual MRI and your lifetime risk may be greater than 20% based on the LCIS history, your doctor would need to evaluate you for that. Our breast team here at NorthShore sees high risk patients with LCIS at all three breast centers, and I would recommend you see one of the breast surgeons here at NorthShore. We have four breast surgeons here at NorthShore.

  Farrah (Lake Forest) - 10:10 AM:
I'm 35 and my mother died of breast cancer at the age of 48. I get an annual digital mammogram and clinical breast exam every 6 months. Should I be getting breast MRI?
Dr. Katharine Yao (NorthShore)
We would need to determine if your lifetime risk is greater than 20% and that involves plugging your numbers into a risk assessment model. This would involve a visit with one of the breast team here at NorthShore. Depending on other risk factors you have you may not qualify for an annual breast MRI just based on your family history.

  Sarah (Highland Park, IL) - 10:13 AM:
I found a lump in my breast, should I get an MRI? What makes someone a good candidate for a breast MRI?
Dr. Katharine Yao (NorthShore)
Indications for MRI are to evaluate high risk patients (patients with suspicious )family history, evaluate for implant rupture, and to evaluate for occult cancer. We use MRI to evaluate newly diagnosed breast cancer patients but this is controversial and there is not a lot of data to support that use. We do not use MRI to evaluate breast lumps as the first test because MRI is expensive and can lead to false positive readings. If you have a lump we always start with mammogram and ultrasound and physical exam first and then proceed from there.

  Caity (Mt. Prospect, IL) - 10:16 AM:
I am 36 and have a family history of breast cancer (my mother died at 39 and my mother's aunt at 59 from it). I have been getting yearly mammograms, but have considered getting an MRI. Would you suggest that I do? Does insurance usually cover it? I have to fight them every year to pay my mammmogram.
Dr. Katharine Yao (NorthShore)
MRI is indicated for patients with a lifetime risk of greater than 20% and this is determined by risk assessment models. This would involve a visit with one of the physicians in the breast center to evaluate your risk. Even though you have two relatives with breast cancer, your lifetime risk may not be greater than 20%. Insurance will not always cover the MRI for high risk patients but if you have seen a breast specialist and had the risk assessment done then there is a higher likelihood that it will be covered. Our breast nurses check with the insurance companies ahead of time to make sure the MRI will be covered. On the other hand, your insurance company should definately cover you annual mammogram. Mammograms in patients with family history is recommended to start at 10 years younger than the affected relative and so you would qualify for annual mmammogram.

  Mary (Niles, IL) - 10:20 AM:
How costly is the test and how likely is insurance to pay for it?
Dr. Katharine Yao (NorthShore)
MRI is approximately $2800-$3000. Whether the insurance company will cover it depends on why you are getting it. Absolute indications for MRI are to evaluate for an implant rupture, to screen high risk patients (patients with suspicious family histories) and to evaluate patients for an occult cancer. Whether patients diagnosed with breast cancer should get a MRI is controversial although most insurance companies will cover it. Ironically, we have more data to suppport MRI for high risk patients than breast cancer patients but the insurance companies always give us a hard time for the high risk patients.

  Aynslee (Park Ridge, IL) - 10:25 AM:
Will I experience any tenderness or pain in my breasts after the MRI?
Dr. Katharine Yao (NorthShore)
You have to lie on your stomach to have the MRI and the breasts fall into holes on the table but there is no compression of the breasts. It is somewhat claustrophobic so beware of that. The test takes about an hour give or take.

Dr. Katharine Yao (NorthShore) - 10:29 AM:
And I might add the test is a little loud.

  Carrie (Evanston, IL) - 10:29 AM:
You mentioned MRI is approved by the ACS for screening in high risk patients - what is its role in breast cancer patients?
Dr. Katharine Yao (NorthShore)
Very controversial and the ACS does not address this group of patients in their guidelines. MRI is very sensitive for picking up cancers but at the same time it can lead to false positive results-that is overcalling something which leads to more tests and even unnecessary biopsies or at worst unnecessary surgeries. There are only a couple of studies out there on MRI for breast cancer patients and so far it does not appear that MRI leads to better breast cancer recurrence rates but the data is scant and there are some problems with the study design. Bottom line it is controversial and each center performs breast MRI on a different basis. Here at NorthShore, we are conducting a prospective study on breast MRI and we hope this study will help us determine which breast cancer patients are benefitting from the MRI and whether we need to do MRI on all breast cancer patients. I suspect that we will not need to do MRI on all cancer patients but we will have to see what the data show

  Farrah (Lake Forest) - 10:34 AM:
What does research show about the efficacy of breast MRI?
Dr. Katharine Yao (NorthShore)
There are at least 5-6 randomized studies of breast MRI in the high risk patients (BRCA positive, suspicious family history) that showed that MRI detected cancers more accurately than Mammogram or ultrasound. In newly diagnosed cancer patients the efficacy of MRI is controversial. One study showed no difference in recurrence with the use of MRI but that study was not the best constructed study. There is a randomized trial in the United Kingdom on breast MRI which has not shown any difference in recurrence or any advantage to breast MRI but the follow up time is short. I would recommend MRI for high risk patients and for newly diagnosed breast cancer patients I would use it with caution understanding its drawbacks.

  Aynslee (Park Ridge, IL) - 10:38 AM:
Are MRIs dangerous to your health?
Dr. Katharine Yao (NorthShore)
You do get a contrast injection and the MRI department will screen your medical history ahead of time to determine if there are any contraindications to getting a MRI. Otherwise it is not a dangerous procedure compared to a lot of other procedures or tests out there.

  Aynslee (Park Ridge) - 10:39 AM:
Can I have some tips on how to keep still during an MRI?
Dr. Katharine Yao (NorthShore)
I don't have any magic thing to recommend. Unfortunately you cannot listen to music or wear headphones because the MRI is a magnet and no metal is allowed in the MRI machine. They do pipe in music as far as a I know. if you have bad claustrophobia you can take some valium ahead of time which your primary doctor would have to prescribe.

  Sarah (Highland Park, Illinois) - 10:43 AM:
You mentioned checking for contraindicationos of getting an MRI. What kind of factors would be seen as contraindications?
Dr. Katharine Yao (NorthShore)
THe MRI uses a magnet so you cannot have any metal (jewelry, etc..) in your body, or any implantable devices. There is a whole list of things that you cannot have on your body to get the MRI which the MRI department will screen you ahead of time for. The contrast that is injected during the MRI can cause kidney problems so if you have any kidney disease then you may not be a candidate for the MRI.

Dr. Katharine Yao (NorthShore) - 10:51 AM:
Looks like we have run out of questions, I appreciate your participation and if you have any further questions please call to make an appointment with me, 847-570-1327. We have three comprehensive breast centers at Highland Park Hospital, Glenbrook Hospital and Evanston Hospital and we see patients at all three centers. My secretary can help you get into whichever center works best for you.

Moderator (Moderator) - 10:54 AM:
Thank you again for participating in our chat today. For more information please visit our Breast cancer pages .

Also, a transcript of this chat will be available shortly.

This chat has ended.

Thank you very much for your participation.