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    Posted: Dec 16 2007 at 9:18am
From Dr. Susan Love's Blog on the Symposium

"MRI and Imaging
MRI certainly dominated the discussions of imaging. Most interesting was the update of a Dutch study that used clinical breast exam, mammography, and MRI to follow high-risk women, including women who have a BRCA 1 or BRCA2 mutation. This was the study that put MRI on the map as a sensitive (finds more tumors) but not so specific (finds lots of irrelevant stuff too) test for screening breast cancer, and that resulted in the recommendation that MRI be used for mutation carriers.

This update had good and bad news. The good news is that MRI is finding DCIS in women who have BRCA 2. However, mammography was still better at finding DCIS than MRI. The disappointing news was that 37 percent of BRCA 1 carriers had interval cancers. This means the MRI missed the cancer, as it was found during the interval between annual screening tests. The women also had more tumors over 2 cm and more frequently had positive nodes. This probably reflects a more aggressive biology, but it also suggests that yearly screening may not be enough. Whether this means we should do screening more often or that prophylactic surgery is indicated in these women is not yet clear. It certainly says to me that the biology of the tumor dictates when it is found rather than the technique that is looking for it!"

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