by Marsha Allen

I first felt a ripple in my breast in early 1996 and saw three different doctors from the spring to the fall, but no one could feel anything. In October, I had a mammogram and areas of concern were found in both breasts. Dr. Duven did a bilateral biopsy and cancer was detected in the right breast.

In December of 1996, at the age of 54, I had a lumpectomy of the right breast. My youngest daughter had just graduated from college and moved home to help out. I had no trouble with the surgery or radiation that followed except for burning on the breast and a very, very sore nipple. The staff at the Cancer Treatment Center made the 10 minutes a day I spent there a breeze. I was then put on Tamoxifen but wasn’t able to tolerate the drug.

My husband and family were very supportive but we felt that I had been handed a death sentence as both my grandmothers and my mother died from cancer, as well as my mother-in-law. Five years passed quickly and I went in for my last check-up with mammogram. I was riding on air. I had made it to the five year mark!

However, I received a call telling me that I needed my right breast biopsied. It turned out to be an aggressive cancer. I had decided that if my cancer ever returned, I would go the M.D. Anderson Cancer Research Center in Houston, Texas. Surgery took over 12 hours – I had a mastectomy, rebuilding of the right breast, and reduction of the left breast.

As the physician was finishing the reduction on the left breast, he felt an area of concern and did a biopsy that came back as cancer. This cancer had not shown up on any mammograms in Iowa or Texas. The surgeon was called back in and a lumpectomy was then performed on the left breast. My sister was waiting for me when I got out of surgery and was the best moral support that I could have asked for. I brow beat her into singing hymns for me as I thought I was dying. I had no feeling in my right arm or strength in my fingers to push the morphine button.

I had nine giant (bagel sized) drainage tubes in me but by the second day I was walking around the nurses’s station. Twelve days later I was back in Iowa and shortly began aggressive chemotherapy which was very rough. I often felt unwell, but did not want to give into the discomfort. I got dressed and went out to breakfast each morning, though sometimes my mouth was too sore to eat. I felt God was only going to give me so much time, so I was going to do what I wanted with it.

Sitting home and complaining just didn’t fit my agenda. I lost all of my hair so I bought a wig, but it itched my head and it was cold. I began to use turbans which I liked better. However, one Sunday I was in church and became overheated and sick. I thought either the turban goes or I go. I reached up and took that thing off my head, right in front of God and everyone else!

It was liberating. It was wonderful. After that, I went bald.

Today I look on each day as a special blessing from God. I take each day, one day at a time. I look forward to my church meetings, my Red Hat meetings and my garden club meetings. I visit my children and grandchildren. I plan for the future, but I also enjoy today – for this is the day the Lord has made, let us rejoice and be glad in it. 

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by John Halloran, M.D.

Although MRI is not a new imaging tool, effective breast MRI for cancer detection has developed only over the last several years. For many years MRI has been used to evaluate breast implants for rupture and now is one of the most exciting and promising tools in the fight against breast cancer. There are two types of MRI scanners: “open MRI” and “high field MRI”. Open MR scanners have a more open design suited for patients who are claustrophobic. Another advantage of the “open MR” is that biopsies can be performed without having to remove the patient from the scanner. “High field” MR scanners have a short tunnel (called a gantry) and are similar in shape to a computed tomography (CT) scanner. MRI works by using a magnetic field.

Breast MRI examinations require the patient to have an intravenous (IV) catheter for administration of MRI contrast dye. Contrast is administered because it helps detect tumors. Many new, abnormal blood vessels form within tumors resulting in a much greater number of blood vessels in tumors than normal breast tissue. Consequently, more contrast dye localizes in the tumors than in the normal breast tissue making tumors appear “bright” and more easily identifiable on the MRI images. Some benign breast lesions may appear “bright” on MR images. Approximately one-third of lesions thought to be cancer on MR turn out to be benign lesions. Therefore, it is important to have the ability to perform MRI guided biopsies at the site performing breast MRI. This allows biopsy of tumors that may be evident only on MRI.

Advantages of MRI over mammography and CT include no radiation exposure and superior sensitivity in detection of subtle differences in the breast tissue. Disadvantages of MR include the cost and its limitation in distinguishing benign from malignant tumors.

Potential Uses of Breast MRI

• Screening patients with breast implants and/or “dense” breasts
• Breast cancer treatment planning: size and number of tumor(s)
• Problem solver
  

“Dense” breast tissue may obscure breast cancer on mammography. Breast implants limit visibility of breast tissue on mammography. MRI does not have these limitations.

The sensitivity of mammography in the detection of cancer in “dense” breasts is reported between 45% to 60% compared to 81% to 95% for MRI. The most exciting capability of breast MRI may be its ability to assist in decisions regarding breast cancer treatment. Effective surgical planning and treatment of breast cancer depends on accurate assessment of the extent of the cancer, the size of the tumor, and the presence of other cancer sites.

MRI clearly is better than mammography in identifying additional sites of tumor. Breast cancer frequently is present at more than one site at the time of diagnosis. These other tumors may occur adjacent to the known tumor or even in the opposite breast. Identification of more than one tumor ​may change cancer therapy. The presence of more than one tumor may result in higher rates of cancer recurrence and may be a contraindication to breast conservation surgery. A University of Pennsylvania study showed more than one-third of patients with breast cancer had more extensive disease depicted on MR compared to mammography and treatment planning was altered in more than one-third of these patients (based on the MRI information).

​MRI effectively screens for cancer in the opposite breast. In an American College of Radiology Imaging Network study, 9% of patients diagnosed with breast cancer had a cancer in the opposite breast as well. MRI is very effective in determining the size of breast tumors. It has been used to follow the response of cancer to chemotherapy and in deciding between mastectomy and breast conservation surgery after completion of chemotherapy.

Breast MRI can be a problem solver. It is used to evaluate patients with inadequately visualized or indeterminate lesions on mammography and patients with atypical findings e.g., negative mammogram and enlarged axillary (arm pit) lymph nodes. A study by the University of Pennsylvania and Mayo Clinic showed MR clearly defined all breast lesions that were poorly demonstrated on mammography. In addition, MR successfully identified 86% of breast malignancies in patients with axillary lymph node metastases with an unknown site of breast cancer (by mammography and physical exam findings).

Breast MRI is an exciting advancement in breast cancer evaluation. Its diagnostic capabilities are invaluable and these capabilities will continue to grow with the constant advances in MRI technology.


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