Patient With Risk of Breast Cancer Questions Safety of Yearly MRI

DEAR DR. ROACH: Due to a slight genetic risk of breast cancer (my Tyrer-Cuzick Model score was 20.6%), my doctor wants me to get breast MRIs with contrast annually. I am concerned about long-term exposure to the gadolinium-based contrast dye. I’ve learned that this heavy metal is considered safe, but traces of it can be stored in the brain and other body tissues.

I am 49 and in very good health. I also get mammograms annually. I consulted my doctor about spacing out my MRIs every two to three years, but he said I should have an MRI every year. So I could be getting these MRIs for the next 35 or so years. Do the benefits of contrast dye outweigh the harm in a person with my health profile? -- S.A.

ANSWER: I’m afraid I don’t have a good answer for you. It is true that most authorities recommend an intensive breast cancer surveillance program for women at a high risk of breast cancer, in the range of a 20% to 25% lifetime risk. (The average risk for developing breast cancer for a woman born today is estimated to be about 13%.)

The Tyrer-Cuzick model of estimating breast cancer risk tends to give higher estimates than the other commonly used models, such as the BRCAPRO. Other models may not put you over the threshold for intensive screening with MRIs, which is usually combined with mammograms. The question about gadolinium (the chemical element used in the contrast dye for MRIs) is important because some people do store gadolinium in various tissues, including the brain, but the clinical significance of this is unknown. (People with kidney disease can develop a skin disease due to gadolinium, so they aren’t recommended to have MRIs with gadolinium.)

Although gadolinium can stay in the body for months or years, there has been no evidence of harm from gadolinium in brain tissue, despite these agents having been used for many years. Some agents have less retention than others. The U.S. FDA has mandated patient guides for these contrast agents, which relay the information above.

Given that there is a probable benefit to intensive screening for breast cancer in your case due to your high genetic risk, and no more than a theoretical risk from gadolinium, I believe that the benefits outweigh the risks, but I can’t say that with complete certainty.

***

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

Promote Healthy Kidneys

Healthy kidneys are something many people take for granted. But those who want to do everything they can to keep their kidneys healthy can consider the following tips.

• Stay hydrated, but avoid overhydration. Adequate hydration definitely promotes healthy kidneys. But overhydrating has not been proven to enhance kidney function. Adults should drink between four and six glasses of water per day.

• Exercise. Regular exercise benefits various parts of the human body, including the kidneys. High blood pressure and diabetes are two of the biggest risk factors for kidney disease, and regular exercise can reduce a person’s risk of both conditions. However, overexertion can strain the kidneys, so avoid going too hard.

• Speak with a physician before taking vitamin supplements or herbal remedies. Excessive supplementation can harm the kidneys. Discuss any supplements or herbals remedies with a physician before taking them.

• Quit smoking. Smoking decreases the blood flow in the kidneys, decreasing their ability to function at optimal capacity. Smoking also increases a person’s risk of high blood pressure and cancer of the kidneys.

• Eat healthy. A healthy diet decreases a person’s risk for high blood pressure and diabetes. Adhering to a healthy diet and controlling portion sizes can help control weight and blood pressure and contribute to healthy kidneys as well.

• Get screened. Adults who have been diagnosed with high blood pressure or diabetes should make sure their physicians screen for kidney dysfunction during routine appointments.

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