Over the last two decades, survival rates for breast cancer have increased dramatically in the United States. The main reason is that technological advances in imaging and widespread use of screening mammography are helping to detect breast cancer at its earliest stages when it is highly curable. Earlier detection also allows women a wider choice of treatment options such as lumpectomy instead of mastectomy.

Screening mammography, which uses low-dose X-rays, has been able to detect breast cancer in many women who have no signs or symptoms. Digital mammography and ultrasound also are helping to better diagnose breast cancer in its earliest stages.

However, none of these technologies is perfect. Mammography misses some cancers, especially in younger women, in women with dense (less-fatty) breasts, and in women on hormone replacement therapy. Advanced technologies, including magnetic resonance imaging (MRI), which uses a computer, a magnetic field and radio waves (rather than X-rays) to produce detailed images of the soft tissues in the body, is considered one of the best technologies currently available for detecting breast cancer at its earliest stages. MRI is helping to detect and evaluate breast cancers — especially in high-risk women – the other modalities can miss.

Aurora Breast MRI of Orange County has had the Aurora® Dedicated Breast MRI System, the only FDA cleared breast MRI system specifically designed for breast imaging, available to area women since 2007. Recently, Dr. Stephen Feig, Director of Breast Imaging at University of California, Irvine Medical Center, Medical Director for Aurora Breast MRI of Orange County, and President-elect of the American Society of Breast Disease, and Dr. Karen Lane, a surgical oncologist and Clinical Director of the UCI Breast Health Center, talked about the lifesaving advantages of breast MRI.

Who is considered “high risk” and should have a breast MRI every year?

Dr. Feig: The American Cancer Society recommends annual breast MRI screening for anyone who has a 20% or higher lifetime risk of developing breast cancer. I personally recommend that anyone with a 15% or higher lifetime risk of breast cancer be screened annually with MRI and mammography. To determine lifetime risk, you have to look at the patient’s age and family and personal history. Women who are high risk include those who have had a breast cancer or who have very close relatives with breast cancer – a mother, sister or daughter. Breast density is also a factor. Women who have mammographically dense breasts – 50% or more of their tissue is glandular – are at increased risk. Other risk factors are a prior biopsy showing certain high-risk conditions, or being a carrier of the BRCA1 and BRCA2 genes. At our center, we have found that with MRI, we are detecting early cancers in many very high-risk women who have had negative mammograms. While those at risk need to be vigilant, it’s important to remember that of the nearly 200,000 women who develop breast cancer each year in the U.S., 70% have no family history of the disease or other risk factors. Every woman age 40 years or older needs an annual mammogram regardless of her risk factors.

Will my insurance pay for a breast MRI?

Feig: In California, many major insurers, including Blue Cross, will often pay for breast MRI for very high-risk patients. If a screening breast MRI can detect an otherwise occult (tumor that can’t be seen) early breast cancer, the patient may avoid lengthy treatment for metastatic disease and the overall cost to the health-care system will be far less. More insurance companies are beginning to see the benefi ts of a breast MRI for carefully selected high-risk women versus chronic long-term care for advanced breast cancer.

How does MRI work? How long does it take?

Feig: MRI uses a magnetic field and radio waves rather than X-rays to generate 3D images of the breast. A contrast agent (gadolinium) is injected into the patient’s arm. The agent causes abnormal structures (blood vessels typical of tumors) in the breast to light up. It takes about 45 minutes from the time the women enter our center until she leaves. We have three highly expert physicians who read breast MRI here; all are radiologists who specialize in breast imaging. We send our interpretive results along with selected images to referring physicians within 24 hours.

Can breast MRI detect early cancers known as ductal carcinoma in situ?

Feig: Advances in breast MRI technology over the last 10 years has improved its ability to detect very tiny, early cancers known as ductal carcinoma in situ. DCIS has a cure rate of 99% with a 20-year survival rate. If left untreated, DCIS will often progress to invasive disease. It is not an innocuous condition. Our experience is that with our dedicated Aurora® system we are picking up some in situ carcinomas that are missed on mammography. Another advantage is that the Aurora® System provides us with full coverage of both breasts, chest wall and axillae in a single 3D scan with extremely high image contrast and resolution.

How has breast MRI changed treatment planning?

Dr. Lane: MRI is a very useful tool for women who are newly diagnosed with breast cancer because it is more sensitive than mammogram or ultrasound. We often fi nd additional disease that we might not have known about if we were basing our treatment decision on a mammogram and sonogram. This becomes important because if a woman who might have been a candidate for breast conservation – removing the cancer and leaving the remainder of the breast – is found to have additional disease in either areas of the breast, the best treatment for her might be removal of the whole breast or a mastectomy. MRI can be very helpful in finding additional cancers.

Why do you prefer having an MRI before performing breast surgery?

Lane: Breast MRI also can be very helpful in finding abnormalities in the opposite breast that need to be evaluated. MRI can give us a clearer picture of what is going on in both breasts and whether any additional biopsies need to be performed or whether the surgical plan needs to be changed based on those findings. It can help us to understand the 3D-configuration of the breast cancer so that we can attempt to obtain clear margins in hopes of reducing the need for additional surgery.

Who to contact:

For more information about breast MRI, please speak with your physician or contact Aurora Breast MRI of Orange County, UC Irvine Medical Center at 714-456-8198.

About Dr. Feig

Stephen A. Feig, M.D., F.A.C.R., UCI Medical Center’s Director of Breast Imaging and Medical Director Aurora Breast MRI of Orange County, is nationally and internationally recognized for his leadership in clinical mammography, breast imaging research and advocacy of screening. At UCI, he offers his expertise in diagnostic mammography, breast ultrasound and MRI, as well as breast interventional procedures including ultrasound-guided and stereotactic breast biopsies and pre-operative wire localizations. Board certified in Radiology, Feig comes to UCI from Mount Sinai School of Medicine. He received his medical degree from New York University School of Medicine and completed his residency at Albert Einstein College of Medicine in New York. He has received numerous awards and honors, including the Gold Medal from the Society of Breast Imaging in 2003, which credited his many scientific papers with helping to determine how breast imaging is practiced today. He is also President-Elect of the American Society of Breast Disease.

About Dr. Lane:

Dr. Karen Lane, M.D., F.A.C.S., is the Clinical Director of the UC Irvine Breast Health Center located in the Chao Family Comprehensive Cancer Center in Orange, CA.

Dr. Lane is a breast health care physician and scientist whose research focus is on public health aspects of breast cancer. Dr. Lane works with members of the Center for Health Policy Research for her research, in addition to participating in clinical studies. She is also an Associate Professor at the University of California, Irvine.

Article Updated:  October 6, 2009