Sunday, April 1, 2007

Journal Update

It's been a confusing week with two different studies on breast MRI. I have already had a number of patients call, trying to figure out what it means.

MRI for Screening

The American Cancer Society released new guidelines for use of MRI breast screening. They recommend screening for women who have been tested and are positive for the genotype BRCA 1 or 2 or for those that are first degree relatives of BRCA carriers. A first degree relative is a parent, child or sibling. They also recommend annual MRI screening for women who have had prior radiation to the chest between ages 10-30(for instance treatment for Hodgkins Disease).
The ACS does NOT recommend MRI for women with dense breasts or women with a personal history of breast cancer. They do not recommend MRI for women with atypical hyperplasia of the breast or lobular carcinoma in situ.
(American Cancer Society)

MRI in Opposite Breast after diagnosis of Breast Cancer

A 2nd report was released that looked at using MRI in the opposite (contralateral)breast after breast cancer is diagnosed. They found a 3% pick up rate for breast cancer in the opposite breast when MRI was done within two months of diagnosis. They also had a very high rate of false positive diagnoses that lead to many invasive procedures. MRI is quite accurate in showing where there is no cancer (true negatives) and the test might be useful in women who are considering a prophylactic mastectomy and would forgo this operation if she knew there was no cancer in the breast. Because MRI picks up many artifacts that are not cancer and the only way to know is to do biopsies, it is not to be considered a simple, non-invasive test.
(New England Journal of Medicine)

Cardiac Arrest

An interesting study came from Japan where researchers looked at out of hospital sudden deaths or cardiac arrest. Less than 1/3 of arrests that occur outside of a hospital receive any type of resuscitation. Many people are afraid to do mouth to mouth breathing and don't feel comfortable with Cardiopulmonary resuscitation (CPR)
They found that chest compressions only were just as effective as CPR and mouth to mouth breathing offered no extra benefit.

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