21 Using this risk assessment tool may initially require a longer visit when you get your annual mammogram or have your annual check-up. This is largely due to the added time needed to compile your extended family history and other information that you might not readily know during your first assessment. I believe the extra effort is worthwhile. I recently encountered a patient who was not high risk according to the Gail model. However, when assessed with Tyrer-Cuzick, she was identified as having a lifetime risk of greater than 20%--just barely over the threshold needed to qualify for additional testing. Her mammograms showed no signs of breast cancer. She was recommended for screening breast MRI due to her lifetime risk being greater than 20%. Breast MRI (magnetic resonance imaging) is the most sensitive test to detect early breast cancer in high risk women. It can show abnormalities in dense breast tissue that may be missed with mammography. It is the best method to evaluate women with implants, as implants can obscure breast tissue on mammogram images. It can also be used for more accurate pre-operative planning and staging, and to effectively monitor the effect of chemotherapy and cancer recurrence. The patient underwent screening breast MRI and was found to have an irregular enhancing mass, not present on mammograms, within her breast. This mass was confirmed on ultrasound, and subsequently biopsied. The biopsy was positive for malignancy and the patient will undergo the appropriate treatment. I feel like this is an important story to tell especially since the type of breast cancer that was diagnosed is usually not well seen with mammograms and can often present when it is quite advanced. It is important to note that this case is not an isolated incident; it is not uncommon for breast MRI to find certain types of breast cancers that are not visualized on a mammogram. In fact, new evidence has surfaced showing that breast MRI can be highly revealing, even for women at average risk for breast cancer. WomanToWomanMagazine.com “Digital mammograms, Breast MRI, and Ultrasound combined are often necessary to diagnose breast cancer in high-risk women”
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