Breast MRIs/ Molecular Breast Imaging/ high risk for breast cancer

Hello all,

I wanted to update everyone on an issue I've been trying to resolve for YEARS. 

When I received my pacemaker six years ago, I made sure that I got something that was MRI compatible. Good thing, since six months later I had a hemorrhagic stroke and multiple brain MRIs since then. 

I'm also at extremely high risk for breast cancer, due to chest radiation I had for cancer as a young adult. Because of that risk, I'd been having screening breast MRIs prior to getting the pacemaker. However, even though I obviously CAN get MRIs, I couldn't find anyone to actually do one or any information about whether the image would be useable or whether the risk is worth the information they'd be able to get. The device is in one of the highest risk areas of my breast.

I was finally offered the opportunity to get a molecular breast image, an MBI, but that took over three years to happen. I won't get into the bureaucratic nightmare that has been. Suffice to say I do have a new primary at the cancer hospital and the actual MBI was a good experience once it finally happened. 

It is safe for those who have pacemakers and is not as uncomfortable as a mammogram (which you still have to get, by the way).

The way it works is they inject you with a very tiny dose of radioactive dye, the same as is used for heart imaging, but a lower dose I think. They position you, sitting, in a machine that uses plates to hold your breast. It's similar to getting a mammogram but much less squeezy. Plus you're sitting down, and there's a TV on to keep you occupied, because you have to hold the position for a long time - like 20 minutes. I can't remember how long each view was, but I think the total was under an hour, and that included for me some mammo views since the local place I'd gotten one at last fall didn't have everything they needed up to their standards. 

Anyway, I know I'm not the only one in this boat, needing additional screening due to high BC risk but being excluded due to the pacemaker - which, in my case, is also due to long-term chest radiation effects. Everything for me turned out to be A-OK, which was quite a relief. Besides being at very high risk, I have dense breasts and that makes certain cancers harder to spot on mammograms. Not getting the additional screening from MRIs was definitely stressful.

The technology is not readily available everywhere, but I will say that my insurance company was more than happy to approve the "experimental" procedure - which is much cheaper than an MRi. It was the hospital end that kept screwing up the paperwork they needed. I know that Mayo and MD Anderson are instutions that have developed this modality. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) provides a list here of other institutions in the US that do Breast MBIs: https://www.snmmi.org/AboutSNMMI/CommitteeContent.aspx?ItemNumber=35578

Anyway, hope this information helps someone else in the same boat! There are a lot of women out there who have pacemakers but still need additional screening, due to prior chest radiation at a young age, BRCA genes, or other factors. 

6 Comments

MRIs

by AgentX86 - 2021-07-08 18:45:30

I know nothing about breasts (well, not nothing but...) but wanted to clear something up about pacemakers.  No pacemakers are "MRI compatible".  Later ones are "MRI conditional".  As long as a list of conditions are met, an MRI is possible. 

As you've found, that doesn't mean that anyone will actually do one.  I found that it was hard enough to get an MRI of the head. I'm sure they'd freak out if they had to do anything around the PM.  It should be possible, though.

Good information.  It's a shame there isn't a way to highlight such articles so they can be found easily.

MBI

by Julros - 2021-07-09 01:26:31

Good information to have. I finally got around to getting a mammogram and although uncomfortable, the tech was very accomodating and apparently obtained adequate pictures for screening without needing other modalitites. 

Thank you Elisabet

by Gemita - 2021-07-09 05:26:31

for sharing this valuable information and for your personal history.  

I also have dense breasts and really need to get some imaging done because I am well overdue.  Since I am over 70, I am not routinely or automatically offered a screening test every couple of years, although I may request this periodically or my doctor may order immediate screening.  I live in the UK.  Uncertain of availability of MBI here, but nonetheless need to speak to my doctor about imaging (mammogram) fairly soon.

I suppose I have been putting off getting a mammogram because I have been fearing the additional discomfort with the pacemaker. I tried asking for an ultrasound test instead of a mammogram a few years ago but my request was not accepted, so I cancelled my mammogram at that time.  Foolish, I know, especially since mother and sister both had breast cancer.

AgentX86, yes I would like to see our search engine improved or to include a few additional helpful topics, although I see if I type in breast in the search facility, this brings up Elisabet's post.  I will ask Admin if there is a possibility of including a new subject under Learn to accommodate some useful articles, although I see we already have Weblinks under Learn, so perhaps something could be included there.

Mammogram

by Betts - 2021-07-10 00:47:56

I too have postpone my mammogram fear of pain and breaking leads just all things that could go wrong

Thanks for the tip!

by asully - 2021-07-10 02:27:26

I too have dense breast tissue and had my first mammogram a few months ago.  I didn't find it that unpleasant, certainly not painful as many women say.  They explained to me that the images weren't great because of how dense my breast tissue was but "adequate".  Maybe this will be something I can look into next time.  They also used ultra sound after the mammogram to check out certain areas they had trouble looking at clearly.

Odds and ends

by Elisabet - 2021-07-12 05:21:57

Thank you, AgentX86 for the clarification! I don't know why I typed "compatible" instead of "conditional" - I do know that one! Getting an MRI is certainly a production. 

Those of you who are putting off getting mammograms, especially those who are higher risk (Gemita, looking at you) - let me encourage you to go ahead and get the test. The techs should be very careful and accomodating of the pacemaker. Mine at least have been super careful when doing the compression not to go past what I could tolerate. Worst case, I suppose, they don't get quite as good a view on one side. 

FYI there's a newer technology, tomosynthesis or "3D", that replaces one of the views on each side with a mini CT scan that takes a couple of seconds. It generates a 3D image that is easier to read and is supposed to give better results for dense breasts. 

One general word about mammograms - if you aren't menopausal, try to schedule it for a time of the month when your breasts are less tender. Believe me it makes a difference. 

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