For women with very dense breasts or a strong family history of breast or ovarian cancer, MRI can yield much greater detail than mammography. MRI is so sensitive that it can reveal many types of suspicious growths in the breast. For this reason, there may be more false-positive findings leading to some unnecessary biopsies and additional scans. But for women at high risk for the disease, MRI can find tumors when they are most treatable.
Breast MRI requires special equipment, software and trained radiologists, and the expense can be 10 times the cost of mammography. In addition, breast MRI may not be available outside large cities.
Women at high risk are defined as having at least a 20 to 25% chance of developing breast cancer over their lifetime. Most U.S. women have about a 9% lifetime risk. Those who inherited defective BRCA1 or BRCA2 genes – a condition involved in only 10 percent of breast cancers – have a lifetime risk ranging from 36 to 85% of getting the disease. Especially at risk are those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested.
Using MRI for breast scans is especially useful for women who have been diagnosed with cancer in one breast and who need to know the status of the other breast. This sensitive technology can find tiny tumors that mammograms have missed. If an early cancer is detected in the other breast, both can be treated at the same time. Studies have shown that 10% of women with cancer in one breast over time will also develop it in the second breast.
MRI scans are most useful in younger women with cancer diagnosed in one breast and those with dense tissue that mammograms do not clearly image. Older, post-menopausal women with early tumors and clear mammograms are less likely to need MRI imaging.
Breast MRI can cost between $1,000 and $2,000. It may not always be covered by medical insurance. Figuring out just who needs MRI scans in addition to mammography can be difficult and much will depend on having a knowledgeable referring physician. A simple risk calculator is available online at http://www.cancer.gov/bcrisktool/. Genetic counseling can also be valuable in determining a woman’s level of risk.
Sources: New York Times ; MSNBC
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March 31st, 2007
Researchers in Germany have used a technique called diffusion tensor imaging (DTI) in a study that examined brains of healthy volunteers and those with chronic back pain. They discovered that the brain in patients with chronic back pain had a more complex, active microstructure in regions associated with pain-processing, emotion and stress response.
The study findings were presented at the annual meeting of the Radiological Society of North America, held in Chicago recently. Researchers indicated that DTI demonstrates chronic pain is real and could help treatment research. Patients who suffer back pain sometimes have difficulty convincing their physicians, relatives, and insurance carriers of their genuine distress. Spinal MRI images do not always clearly demonstrate the source of pain.
According to the lead researcher, a radiologist in Munich, Germany, the objective and reproducible correlates in brain imaging should change the way chronic pain is perceived. It need no longer be a subjective experience. For pain diagnosis and treatment, the consequences could be huge. As a result, clinicians may direct therapeutic attention from the spine to the brain.
What is unclear is whether the brain in certain individuals is predisposed to developing chronic pain, whether ongoing pain causes hyperactivity and change in the brain’s organization or a combination of both.
Physicians who treat patients with chronic back pain have long known that chronic pain can begin with a serious injury. Even after healing has occurred, the brain continues to send pain signals for these individuals. The new imaging technology DTI will be able to validate their theory that the nervous system has been “rewired.â€
This study adds to the growing body of research showing that chronic pain is associated with physical changes in the brain. Chronic is defined as lasting more than six months.
In some cases, back pain plagues individuals for many years after their initial injuries.
This study helps the medical community to understand how the central nervous system is involved in back pain. More research is needed to determine what the brain’s physical changes mean and how to most effectively treat the pain.
Source:Â BBC News
February 20th, 2007
Women with very dense breast tissue are five times more likely to get breast cancer than those whose breasts contain more fatty tissue, according to a recent study. Doctors should discuss this particular risk factor with their patients who have mammograms.
Fat appears dark on mammograms, but dense tissue is light like tumors, thus more easily hiding cancers. Not only are breast cancers more likely to be hidden by white on white, they also appear more frequently in dense breasts.
Density is a true risk factor, along with other strong predictors such as the woman’s age and whether she carries BRCA1 and 2 gene mutations. Yet, this condition is rarely taken into consideration or discussed between doctor and patient.
This new study — involving 1,112 women whose medical records were examined at cancer centers in Toronto and Vancouver, Canada — is published in a January 2007 issue of the New England Journal of Medicine. Women taking part who had at least 75% dense breasts showed five times more likelihood of developing cancer over the time frame studied than women with less than 10% density. It confirms previous studies that pointed to the masking effect and a separate biological risk.
In this particular study, cancers were 18 times more likely to be found in women with the densest breasts within the first year after their mammograms. These cancers were judged to have been present earlier but masked by the difficulty in diagnosing their condition.
Breast density involves the presence of more connective, duct-lining and milk-gland tissue than fat tissue. It is impossible for a woman to judge the density herself. It must be routinely evaluated with a mammogram.
This most important factor to note is that extremely dense breaks are “an incredible risk factor†that probably accounts for a large percentage of breast cancers being found. Woman whose mammograms indicate dense breast tissue should be followed up rapidly with more sensitive technologies such as digital mammograms, sonograms or magnetic resonance image (MRI).
Some medical experts believe that women with this significant risk factor may be one day be cautioned to make lifestyle changes and even be prescribed medications for cancer prevention. If genes that promote density can be identified, they could serve as targets for cancer drugs.
Source:Â Associated Press; CNN HealthÂ
January 20th, 2007
Until recently it was thought that Alzheimer’s patients could not feel pain. Now it is understood that they feel pain as powerfully as others, maybe more so, but are unable to verbalize their feelings. This may be so especially for those in the later stages of the mind-robbing disease. Because they have lost communication skills, their pain may be under-treated by physicians and caregivers.
An Australian study using MRI real-time brain scans to check the brain’s major pain channels gave clear evidence that pain may still be intensely felt in the Alzheimer’s patient. The study compared Alzheimer’s patients who could still describe their pain to other study participants who were volunteers without the disease.
In this study appearing in an online edition of the journal Brain, study authors concluded that dealing with pain became problematic because diseased patients were unable to divert their attention from it, as healthy volunteers were able to do. If patients in the study who could still communicate found pain to be bewildering, it might be even more so for those with Alzheimer’s.
When words can no longer adequately express pain, doctors and other caregivers can look for facial expressions and body movements that show discomfort. Often, the Alzheimer’s patient’s caregiver has a greater capacity to understand these signals of pain than even their physicians. They look for signs of agitation, altered eye contact, grimacing, or other indications.
It is generally impossible to totally eliminate pain in Alzheimer’s patients or in other persons with chronic pain. The goal for those with Alzheimer’s Disease or other dementias should be to find greater levels of comfort and pain management.
Source:Â Web MD
October 1st, 2006
A new model for assessing a woman’s risk of developing breast cancer indicates that breast density is as important a factor as their age, family history, or prior breast biopsy. In a study that included more than 1 million women receiving annual screening mammograms, 11,638 women were diagnosed with breast cancer within a year.
Those more likely to develop breast cancer were found to have very dense breasts. These women are more difficult to image, as milk gland tissue and cancer tumors both appear white on the mammogram. Fatty tissue is less dense, appears clear, and is therefore easier for radiologists to find tumors.
After adjustment for age, study researchers found that the risk of developing breast cancer was nearly four times greater for women with very dense breasts, compared to women with mostly fat tissue in their breasts. Post-menopausal women tend to have less dense breasts that include more fatty tissue.
The new prediction models are expected to help doctors identify women who are most at risk for breast cancer so that necessary interventions may take place. Additional screening using sonograms or MRI are more effective for identifying tumors in women with dense breasts.
This study, published in the September 6 issue of the Journal of the National Cancer Institute, is the largest study so far in terms of population size and the number of risk factors examined.
Source:Â ScienceDaily.com
September 26th, 2006
Women who have inherited gene mutations that increase their risk for breast cancer may benefit from having annual magnetic resonance imaging (MRI) in addition to mammograms.
Defective BRCA1 and BRCA2 genes can increase a woman’s lifetime risk of getting breast cancer by 45% to 65%, according to a study published recently in the Journal of the American Medical Association. However, inherited gene mutations account for only 5% to 10% of all breast cancer cases.
Mammography is usually an effective screening tool for detecting breast cancer, but the results are not always accurate. For women with especially dense breasts, mammography can be inadequate. MRI is a much more sensitive imaging technology for these women. The drawbacks are that MRI is ten times as expensive and can increase the risk of false-positive results.
Women from families with strong histories of breast cancer often have genetic testing to learn whether they have inherited mutations in their BRCA1 and/or BRCA2 genes. If these genes are defective, they are also at higher risk for ovarian cancer.
Women with known genetic susceptibility sometimes opt to have both breasts removed (bilateral mastectomy), or they take drugs such as tamoxifen in hopes of preventing cancer. Others decide to follow screening guidelines and deal with breast cancer if and when it occurs.
After age 25, annual mammograms are recommended for women with mutations in BRCA1 and BRCA2 genes. Breast cancers are generally rare in women under age 35. For high-risk women between ages 35 and 55, annual screening with MRI and mammography would be a sound investment in their health. After age 55, women’s breasts are not as dense, and mammography alone would probably detect even small cancers.
Improvements in mammography including digital mammograms could soon make that technology almost as sensitive as MRI and also more cost effective.
Source: WebMD
Technorati Tags: Cancer, Breast Cancer, Womens Healthcare
June 3rd, 2006
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