In this video Dr. Harness explains some of the common steps for a breast cancer patient after a breast MRI.
Jay K. Harness, MD, FACS: I have shared with you previously my bias and strong feelings that breast MRI has a very important role in the evaluation of newly diagnosed patients for breast cancer. I have also previously shared with you that there is certainly two camps and we are fighting over this, and I won’t get into those arguments and discussions at all.
We received a question at breastcanceranswers.com about, “Gee, I have my breast MRI, what is next?”
Well, without any details about the source of this question or where the breast MRI has been done, as part of the evaluation, I can give a pretty global answer to this sort of question.
First of all, most insurance companies won’t even approve breast MRI unless you have got a core biopsy diagnosis of breast cancer. The main indications I think for breast MRI are to look for what’s called ‘multifocal’ and ‘multicentric’ disease and I believe I have explained the difference between those two with an earlier video answer.
Extent of disease is important to us and I have also shared on another video when it comes to nipple-sparing mastectomies, breast MRI is quite helpful to us in knowing that the nipple areolar area is not involved with the cancer.
So typically, the breast MRI is done after the digital mammograms, typically after the ultrasound, and clearly after you have an established diagnosis of breast cancer. So what’s next frankly depends on the results of the breast MRI.
I do not know the exact number but roughly probably about 15% of the time, additional biopsies may be needed. There is a second or third suspicious area that may require either a second look ultrasound to see if something is there and possible additional biopsies, or in my practice, if we do not see anything on second look ultrasound, an MRI-guided biopsy, which may indeed show multifocal or multicentric disease.
Breast MRI can be helpful also in seeing if lymph nodes inside the chest in the axillary area and in the base of the neck are grossly involved because that may then result in an ultrasound-guided biopsy to see if the patient already has metastasis to lymph nodes.
Other roles for breast MRI in the whole process is the follow up imaging of patients who have had locally advanced breast cancer, stage-3 breast cancers, or after all of their treatments, particularly including even mastectomy and reconstruction, the breast MRI may be very important to us in detecting recurrent disease, and typically in that situation, the insurance companies will cover that.
Finally concerning whether the insurance companies will cover the cost of breast MRI – as far as follow up, we know that in BRCA1 and BRCA2 gene-positive patients, MRI is part of the annual screening process and also in patients who have a lifetime risk of breast cancer greater than about 22-23%.
So hopefully, this gives you an overview again on where breast MRI fits in to the scheme of things in the treatment, diagnosis, and follow up of breast cancer patients.
Dr. Jay K. Harness is a board certified surgeon currently treating patients at St. Joesph Hospital in Orange, CA. Dr. Harness specializes in complete breast health, breast cancer surgery, oncoplastic reconstruction, genetic screening, management of breast health issues, risk assessment and counseling. Dr. Harness is the medical director for Breast Cancer Answers.com, and guides this first ever social media show’s information by drawing on his former leadership experience as the President of the American Society of Breast Surgeons and Breast Surgery International. Dr. Harness graduated from the University of Michigan, Ann Arbor in 1969 and spent time early on in his career at the University of Michigan Medical Center.
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided on this site solely at your own risk. If you have any concerns about your health, please consult with a physician.