In the early days of mammography, there was some discussion among physicians that the X-ray dose was possibly going to cause more cancer than was diagnosed. That was actually disproved, but it was quite controversial for a time. It even led to a recommendation that a screening mammogram be just one view of each breast because of the perceived fear of the radiation. There's actually been no evidence that breast cancer has been caused by imaging, and the dose has decreased since the beginning.
For this particular woman, I would advise her to continue to have a mammogram, a clinical breast exam, and ultrasound if needed for screening for breast cancer. These are still the most reliable tools that we have for detecting early cancer and recurrence. MRI at this point is a secondary tool. We don't have any evidence of its efficacy over time or how often it should be used. PET scanning is for the entire body rather than just the breast. PET can be used to check for metastatic disease, but not as a routine tool.
You may find that doctors in different institutions and in different parts of the world have different opinions and different styles of practicing medicine. For example, at Memorial Sloan-Kettering in New York, they are integrating MRI scanning into the follow-up of women who've had breast cancer personally, as well as in women who've not had breast cancer, but who are at high risk because of a known inherited gene abnormality. Until the role of MRI scans is better understood, it's hard to come up with strong recommendations one way or the other. It is a very useful tool under a number of different clinical circumstances. These tests in combination are likely to give you the best information.
It's also important for the test results of each of these studies to be correlated with the other studies. For example, you are likely to learn much more about the health of your breast if your radiologist is looking at both your ultrasound and your mammogram and combining the information. If you have each of these tests in two different institutions, it's possible you may not capture the full amount of information available.
For this particular woman, I would advise her to continue to have a mammogram, a clinical breast exam, and ultrasound if needed for screening for breast cancer. These are still the most reliable tools that we have for detecting early cancer and recurrence. MRI at this point is a secondary tool. We don't have any evidence of its efficacy over time or how often it should be used. PET scanning is for the entire body rather than just the breast. PET can be used to check for metastatic disease, but not as a routine tool.
You may find that doctors in different institutions and in different parts of the world have different opinions and different styles of practicing medicine. For example, at Memorial Sloan-Kettering in New York, they are integrating MRI scanning into the follow-up of women who've had breast cancer personally, as well as in women who've not had breast cancer, but who are at high risk because of a known inherited gene abnormality. Until the role of MRI scans is better understood, it's hard to come up with strong recommendations one way or the other. It is a very useful tool under a number of different clinical circumstances. These tests in combination are likely to give you the best information.
It's also important for the test results of each of these studies to be correlated with the other studies. For example, you are likely to learn much more about the health of your breast if your radiologist is looking at both your ultrasound and your mammogram and combining the information. If you have each of these tests in two different institutions, it's possible you may not capture the full amount of information available.
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