Breast MRI

Question: I recently had a chest mri at the hospital. After my test I looked online and found information on MRI’s causing causing cancer by a few different ways, such as interfering with DNA repair process and causing free radicals, etc in addition to double strand DNA breaks. I was told to contact someone with academic/research knowledge from the school. So can you let me know if this is in fact an occurrence with MRI scans or has any weight?

Answer: You raised an excellent question. High field strength (>1.5 Tesla) MRI scanners have been around since 1985. Most clinical imaging today is performed at 1.5 or 3.0 Tesla. So far with more than 30 years of experience there is no convincing evidence that clinical levels of MRI are genetically harmful or cause cancer. Even in the worst case scenario, such as repeated exposure (> 100 hours) to 7 Tesla magnets, has failed to show any measurable change in indices associated with genetic damage in human research studies. While there is little evidence to date to show that MRI is harmful, an absolute statement that MRI is 100% safe is not possible. This is an area of medicine of ongoing research. As you indicated there are reports of free radical formation and oxidative stress caused by static magnetic fields however this is produced at extremely low levels or not at all. To put it into perspective, air travel exposes us to increased ionizing radiation which does in fact cause free radical formation and oxidative stress. Ionizing radiation is also associated with x-ray and CT examinations. Ionizing radiation is however not associated with MRI. The radiofrequency associated with MRI is many orders of magnitude weaker than x-rays.

You should always keep in mind that there is always a risk versus benefit ratio when undergoing any clinical test or procedure. I would consider your risk extremely low in this case.

I hope this information helps.

Question: I was wondering if the gadolinium contrast given to me for a few breast MRIs would stay in my body somewhere (such as in my brain). What happens to the contrast after the MRI is finished?

Answer: Thank you for contacting the Breast Imaging Ask an Expert forum. This is an interesting question. Our expert tells us that there are published reports within the last year of gadolinium contrast agents being found to deposit in the brain. This is a newly recognized finding but not likely to be a new occurrence. Although deposition of gadolinium in the brain or any other part of the body needs to be investigated, so far there are no reports that this deposition in the brain causes injury. Recent studies, at least in preliminary results, are showing no effect. In all diagnostic procedures that we perform, contrast materials like gadolinium are only administered if the benefits outweigh the risks. The known health risk of these contrast agents is extremely low in patients with good kidney function, because the kidneys help eliminate gadolinium contrast as quickly as possible. Our experts believe that if an MRI is needed to ensure your health, you should not let concerns about gadolinium deposition discourage you from having the MRI. To schedule a breast imaging procedure at the Memorial Hermann Breast Center, please call 713-512-6040. LBJ Hospital also has quality breast image interpretation by experienced UT physicians, for an appointment call 713-526-4243.

Question: I have a very small palpable lump that did not show up on mammogram or ultrasound, although many other cysts did show up. To be safe, I was sent for an MRI. The results are as follows: “Scattered fibroglandular densities are noted. Innumerable varying sized cysts are present throughout both breasts, probably indicating underlying fibrocystic condition. There is a glandular background element enhancement which does limit assessment; however, no suspicious area of enhancement is seen at this time.” “No suspicious” sounds good to me, but should I be worried about “glandular background element which does limit assessment?” I can’t seem to get it out of my mind that I might have cancer hiding somewhere under all the other cysts.

Answer: Thank you for contacting the Ask a Breast Imaging Expert forum. This is an excellent question. Our experts say that the MRI, while not perfect, is the most sensitive test available for breast imaging. False negative does occur, usually with very small lesions in a background of fibrocystic enhancement, as in your case. A form of breast cancer called low grade ductal carcinoma in situ is another situation where MRI might have a false negative. Our experts did not feel that a follow up with another form of imaging would help you, other than the following: 1) If you notice any changes in a lump that you can feel, contact your doctor, and 2) if you find that you are still anxious about your potential for breast cancer, our experts might recommend an ultrasound in 6 months. Another thing to discuss with your physician is to determine your degree of risk, which may help guide how closely your breast health needs to be watched. You can read about some of the various risk factors that are taken into consideration at www.breastcancer.org. While no amount of imaging will guarantee that you are free from cancer, the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243) can offer you high quality imaging and expert image interpretations for your next breast exam.

Question: I had a mammogram which showed something questionable. Then I had an MRI, and it picked up something that the doctor decided to biopsy. It was benign. I felt like I went thru all that for nothing, and didn’t take my doctor’s advice to keep getting a screening. It’s been 5 years since I had a breast exam. Do you have any advice for me?

Answer: Thank you for contacting the Breast Imaging Ask an Expert forum. We are so glad that you have found the courage to consider having another breast imaging exam! We hope we can encourage you with the knowledge that a person has the highest chance of having a false positive during their first breast exam (all types of breast imaging have some false positives). After that, a comparison with previous breast exams can help explain spots that might otherwise look suspicious. A breast MRI would be recommended for women with the following situations: if you have a breast implant, if you have a history of breast cancer, if you have been newly diagnosed with breast cancer (to get a better idea of the size and shape of the tumor), or if there is an area of concern that was not clarified by the mammogram or ultrasound. (Ultrasound is often done to evaluate specific areas of concern, but is not used for screening). MRI is recommended together with a mammogram for women who have been determined to be high risk, beginning at either 40 or 10 years before their first degree relatives are diagnosed with breast cancer (first degree means mother, sister or daughter), whichever age is younger. The breast imaging staff at UT understands very well the anxiety, pain and expense of having a false-positive experience, and we are doing everything we can to keep these experiences to a minimum. However, we also know that it is far worse to discover a breast cancer that has been allowed to remain untreated for too long without being detected. Today’s breast cancer patient has a better chance than ever to become cancer free after treatment, in part due to early detection. To schedule a breast imaging procedure at the Memorial Hermann Breast Center, please call 713-512-6040. LBJ Hospital also has quality breast image interpretation by experienced UT physicians, for an appointment call 713-526-4243.

Question: I had my first mammogram when I was 35 because my mom had breast cancer at an early age dense breasts. I was told that I have dense breasts, and that I am high risk because of my mom’s cancer. I read that an MRI is more accurate than a mammogram, and I’m really nervous about the possibility of getting breast cancer myself. Should I have an MRI instead of a mammogram because the MRI would be more accurate?

Answer: Thank you for contacting the Breast Imaging Ask an Expert forum. The American Cancer Society recommends that all women over 40 have an annual screening mammogram (meaning having a regular checkup without having any known problem) to detect breast cancer as early as possible. Under the current guidelines for high risk women, an MRI can be added to a mammogram for the annual exam, but should not replace it. At many places, screening breast MRI and screening mammogram are alternated every 6 months. The benefits of MRI in high risk screening has been well researched and well established. MRI is NOT used alone as a screening tool because of the higher risk of a false positive. However, simply having dense breasts and a mother diagnosed with breast cancer at young age does not necessarily qualify you for a screening breast MRI. Insurance companies may not pay for screening breast MRI unless the woman has increased risk, calculated as more than 20% life time risk. Our expert recommends that you request a genetic consultation, which will be able to calculate your risk of developing breast cancer, using various statistical methods, so that the best screening method is used for your individual situation. To schedule a breast imaging procedure at the Memorial Hermann Breast Center, please call 713-512-6040. LBJ Hospital also has quality breast image interpretation by experienced UT physicians, for an appointment call 713-526-4243.