The use of MRI before surgery to assess the extent of early breast cancer may do more harm than good, according to a new review.
The review suggests that MRI raises the chances of more extensive surgery over conservative approaches, with no evidence that it improves surgical care or prognosis.
AdvertisementRandomized 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 researchers 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.
After reviewing the data, the authors conclude that there is evidence that MRI changes surgical management, generally from breast conservation to more radical surgery, but that there is no evidence that it improves surgical treatment or outcomes.
"Overall, there is growing evidence that MRI does not improve surgical care, and it could be argued that it has a potentially harmful effect," said the authors.
They say well-designed, randomized controlled trials are needed to quantify potential benefit and harm, including careful evaluation of its impact on quality of life.
"We acknowledge that logistics and costs of conducting such large-scale, multicenter trials are enormous. If the technology is truly as beneficial as its proponents claim, then these costs are worth it. If it is not, then they are outweighed by the costs of adopting expensive technology and associated intervention without evidence of clinical benefit," they concluded.
The study appears online in CA: A Cancer Journal for Clinicians.