Breast MRIs aid cancer detection


POSTED: Sunday, August 23, 2009

A flier about Kapiolani Breast Center's high-risk program caught Ella Isono's attention after an annual mammogram in August 2008.

Although the 58-year-old woman's mammogram was normal, she was concerned because of her family history of cancer and made an appointment with Terri Imada, high-risk nurse coordinator at the center.

“;On the first visit she was floored—I was really high risk,”; Isono said.

Imada recommended breast magnetic resonance imaging, which Isono did in January. The MRI was abnormal. “;From August to January it had gone from normal to abnormal,”; Isono said, and a biopsy in February “;came back as cancer.”;

“;I'm not as emotionally distraught as someone newly diagnosed without family history,”; she said, explaining that her mother died of breast cancer at age 61 in 1982, and her sister, 57, a Kauai resident, was diagnosed with the disease when she was 42.

Isono said she was only in the seventh or eighth grade when she began having breast biopsies because she “;felt these lumps.”;

In 2007 the American Cancer Society recommended MRIs for patients such as Isono at very high risk for breast cancer and those with newly diagnosed breast cancer.

Dr. Bryan Gushiken, lead radiologist at Kapiolani Women's Center, said studies show 5 percent to 10 percent of patients with newly diagnosed breast cancer could have cancer hiding elsewhere in the same breast or in the other one.

“;You want to know that before you do something,”; he said.

Gushiken noted a case in which a breast MRI showed a lump that had also been found by ultrasound. “;But what was surprising, in a completely different part of the breast was another small, suspicious lump,”; he said. “;We biopsied that. It was the second cancer you couldn't see on anything else.

“;Now this changes her therapy,”; he said, pointing out if the larger lump had been removed, the other one would have been left behind. “;Maybe one or two years later, she might have felt it. It was too small to be seen, and her breasts were so dense.”;

An MRI does not replace a mammogram, which is recommended first, Gushiken said. However, mammograms miss 5 percent to 35 percent of cancers, and “;it's worse in dense breasts”; where they hide, he said.

“;The key difference is we give contrast with an MRI. We inject something into the vein, and tumors love to take up the contrast.”;

MRIs also have some disadvantages, Gushiken said, including costs 10 times higher than a mammogram, a longer exam, claustrophobia for some patients, and high false positive rates leading to anxiety and unnecessary biopsies.

Isono said cancer was identified in the milk ducts of her left breast and was contained, so she had a lumpectomy. More surgery was done in April, and she had a bilateral mastectomy May 18 with reconstruction immediately afterward.

After her diagnosis in February, she had a blood test for the gene mutation for breast or ovarian cancer, and the test was negative, she said. “;For me it was a blessing I did MRI.”;

The MRI “;started my whole journey with cancer,”; she said. “;I needed an MRI to decide if I wanted to do a mastectomy, and I decided anyway because of my family history and risk.”;

Golfing is her passion, Isono said, and the first question after her surgery from her husband, Denis, Central Pacific Bank executive vice president for operations and services, was, “;When can you go back to golf?”;

She said she almost laughed when the doctor said “;in six weeks,”; because she was in so much pain, but she was cleared to golf in that time. And in June an oncologist told her she was cancer free, she said.

Breast MRIs also are being done at Hilo Medical Center on the Big Island, and on Oahu at Straub Clinic & Hospital and Kaiser Permanente's Moanalua Medical Center. The Queen's Medical Center hired radiologist Michael Click, chief of the Breast MRI program at Dartmouth, N.H., to set up a program in the Women's Health Center at Queen's. He anticipates scanning patients before the end of the year.