Utilization of breast cancer screening with magnetic resonance imaging in community practice |
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| Authors: | Deirdre A Hill Jennifer S Haas Robert Wellman Rebecca A Hubbard Christoph I Lee Jennifer Alford-Teaster Karen J Wernli Louise M Henderson Natasha K Stout Anna N A Tosteson Karla Kerlikowske Tracy Onega |
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| Institution: | 1.Department of Internal Medicine and Comprehensive Cancer Center,University of New Mexico School of Medicine,Albuquerque,USA;2.Department of Internal Medicine,University of New Mexico School of Medicine,Albuquerque,USA;3.Division of General Internal Medicine and Primary Care,Brigham and Women’s Hospital,Boston,USA;4.Group Health Research Institute,Seattle,USA;5.Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine,University of Pennsylvania,Philadelphia,USA;6.Department of Radiology,University of Washington School of Medicine,Seattle,USA;7.Department of Health Services,University of Washington School of Public Health,Seattle,USA;8.Departments of Biomedical Data Science and Epidemiology,Geisel School of Medicine at Dartmouth,Lebanon,USA;9.Norris Cotton Cancer Center,Geisel School of Medicine at Dartmouth,Lebanon,USA;10.Department of Radiology,University of North Carolina,Chapel Hill,USA;11.Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,USA;12.Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Management and Norris Cotton Cancer Center,Geisel School of Medicine at Dartmouth,Lebanon,USA;13.Departments of Medicine and Epidemiology/Biostatistics,University of California,San Francisco,USA |
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| Abstract: | BackgroundBreast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice.ObjectiveTo assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications.DesignProspective cohort study conducted between 2007 and 2014.ParticipantsIn five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI.Main measuresLifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression.Key resultsAmong women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts RR 2.2; 95% confidence interval (CI) 1.7–2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9–14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0–60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%–84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1–37.9%) among women considered at low-to-average breast cancer risk.ConclusionUtilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care. |
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