Sarah Walor photo
Tricia Prillaman was fully aware of her odds with breast cancer. Her grandmother was diagnosed with the disease at age 80; her mother's 20-year battle with breast cancer ended when it metastasized and eventually reached her liver; and her sister is a five-year breast-cancer survivor.
Armed with this history, Prillaman, who's now 58, started getting annual mammograms in her thirties. Following her July 2007 mammogram, additional testing in the form of a second mammogram and an ultrasound was ordered because of a suspicious area on her left breast. Dr. Jacquelyn P. Hogge, head of breast imaging for CJW Medical Center, noticed Prillaman's strong family history and also ordered a breast MRI (magnetic resonance imaging), an increasingly important tool for detecting breast cancer in high-risk patients. The MRI cleared up the suspicion in Prillaman's left breast, but found something on her right breast. A needle biopsy determined that cancer was present, and Prillaman had a lumpectomy. The pathologist found no cancer in the tissue that was removed, so a second lumpectomy was performed and Stage 0 cancer (early-stage cancer) was detected. "Years would go by before you detected the cancer by mammography," Hogge says of Stage 0 breast cancer.
Despite the inconvenience of double surgeries, Prillaman credits breast MRI — and the doctor who suggested it — with potentially saving her life by catching her cancer so early.
During a breast MRI, the patient lies on her (or his) stomach with the breasts inserted into two holes on the table; the breasts are not compressed. A magnetic field generates thousands of images — compared to radiation with a mammogram. Images are taken at the onset of the test and then again after a contrasting dye is injected intravenously. Blood vessels in healthy tissue slowly take in the dye and slowly release it, whereas blood vessels in cancerous tissue light up almost immediately with a large amount of dye and leak it out quickly. The test lasts about 45 minutes. The computer subtracts out the two sets of images and leaves behind pictures that need further inspection. After the results are read, the MRI machine can guide doctors to the site for a biopsy.
For the average woman, the mammogram remains the gold standard of breast-cancer detection; MRI cannot detect microcalcifications, which can be cancerous. Breast MRI is usually reserved for women (or men) who are at high risk of developing the disease, including those with a strong family history (at least two first-degree relatives, especially if they were premenopausal when diagnosed, says Dr. Gilda Cardenosa, the Veronica Donovan Sweeney Professor of Breast Imaging at VCU Medical Center); those who had chest radiation early in life for something such as lymphoma; and those who have dense breasts.
Because of the use of a magnetic field, breast MRI is not for patients with pacemakers or metallic prostheses, among other things, Cardenosa says. Most patients can tolerate the contrasting agent, gadolinium, because it's very different from iodine dyes, which can cause allergic reactions among some people.
All of this isn't to say that breast MRI is perfect. "Studies have shown that breast MRI can miss 8 percent to 10 percent of breast cancers," says Dr. Melanie Fidler, chief of breast imaging with Radiology Associates of Richmond at Henrico Doctors' Hospital. "This is lower than mammograms alone, which miss 15 percent to 20 percent of breast cancers."
Still, doctors cannot stress enough that women who don't fall into the high-risk category should continue to get regular mammograms — ideally digital. "Mammograms remain the only test proven to save lives from breast cancer," Fidler says. "Since its initial use, breast-cancer deaths have decreased 30 percent to 40 percent. It is not perfect, but the earlier we find it, the higher the cure rate."
Prillaman has completed radiation treatment and is cancer-free; breast MRIs and mammograms annually are in her foreseeable future. Now she's even more dedicated to making sure her three daughters are prepared to take on their family history. "I don't think they can avoid [cancer]," Prillaman says. "It's definitely made me want to make them more aware of these tests."