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Dr. JAY HARNESS: \expnd0\expndtw0\kerning0 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\'92t get into those arguments
and discussions at all. \ \pard\tx2367\pardeftab720\pardirnatural\qj
\cf0 \ We received a question at breastcanceranswers.com
about, \'93Gee, I have my breast MRI, what is next?\'94 \
\ 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\'92t
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\'92s called \'91multifocal\'92
and \'91multicentric\'92 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 ***-sparing mastectomies, breast MRI is quite helpful to us in knowing that
the *** 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\'92s 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.\
\pard\tx2367\pardeftab720\pardirnatural\qj \cf0 \expnd0\expndtw0\kerning0
\ \
Susan Denver: I am a breast cancer survivor. \
\ Katherine Stockton: I am a breast cancer survivor.
\ \
Coree: I am a breast cancer survivor. \ \
Susan Denver: And I want every woman to know\'85 \
\ Katherine Stockton: \'85about personalized
breast cancer treatment\'85 \ \
Susan Denver: \'85and the Genomic Test. \ \
Coree: A test that helps guide a woman and her doctor\'85 \
\ Katherine Stockton: \'85to the best treatment
options for her. \ \
Susan Denver: Pass it on! }