Breast surgeon repeatedly slams breast MR with same data, questions use in newly diagnosed women

August 21, 2009

For the third time in less than a year, results from a retrospective study of breast cancer cases were framed as new research, challenging the routine use of MRI as a means to improve surgical outcomes in newly diagnosed breast cancer patients. The results, announced in press releases in fall last year and twice this summer, bear repeating, said the principal author of the study, Richard J. Bleicher, co-director of the breast fellowship program at Fox Chase Cancer Center in Philadelphia.

For the third time in less than a year, results from a retrospective study of breast cancer cases were framed as new research, challenging the routine use of MRI as a means to improve surgical outcomes in newly diagnosed breast cancer patients. The results, announced in press releases in fall last year and twice this summer, bear repeating, said the principal author of the study, Richard J. Bleicher, co-director of the breast fellowship program at Fox Chase Cancer Center in Philadelphia.

“Although breast MRI is a useful tool in certain settings, it should not be used routinely in previously diagnosed breast cancer patients until we have data demonstrating that there is some sort of outcome benefit,” Bleicher told ONI.

Release of the same data three times to the general media over a span of less than a year does not reflect an advocacy on his part against the use of MRI among patients with newly diagnosed breast cancer, he said. Instead, each press release was tied to a newsworthy event, according to Bleicher: presentation of a poster at the September 2008 ASCO Breast Cancer Symposium; the online publication in June 2009 of the paper, which was scheduled for publication in the August issue of the Journal of the American College of Surgeons; and the actual publication of the paper in the August issue of the JACS.

The research involved a retrospective review of 577 patients referred to Fox Chase Cancer Center from July 2004 to December 2006. Each patient had been diagnosed with breast cancer by other tests. Bleicher and colleagues found that the 130 patients (22.5%) who had MRIs prior to treatment were more likely to undergo a mastectomy than breast conserving therapy and tended to face delays in treatment while waiting for MRIs to be performed and interpreted.

Bleicher expressed concern that the high false positive rate of breast MRI increases the likelihood that women will choose the more extensive surgical intervention than breast conserving surgery, even when such disease may not be present. In publicizing the Fox Chase study, he said he hopes to better educate women about the shortcomings of MRI so they can make more informed decisions about therapy.

“I want my patients to come in without myths,” said Bleicher, who was careful to note that his concern about the use of MRI is restricted to patients who have been definitively diagnosed as having breast cancer. “We are not talking about the use of MRI to screen high-risk patients (as indicated by guidelines from the American Cancer Society).”

For more on this topic, see “Experts contest article declaring breast MRI causes more harm than good.”