TY - JOUR
T1 - Underutilization of Supplemental Magnetic Resonance Imaging Screening among Patients at High Breast Cancer Risk
AU - Miles, Randy
AU - Wan, Fei
AU - Onega, Tracy L.
AU - Lenderink-Carpenter, Amanda
AU - O'Meara, Ellen S.
AU - Zhu, Weiwei
AU - Henderson, Louise M.
AU - Haas, Jennifer S.
AU - Hill, Deirdre A.
AU - Tosteson, Anna N.A.
AU - Wernli, Karen J.
AU - Alford-Teaster, Jennifer
AU - Lee, Janie M.
AU - Lehman, Constance D.
AU - Lee, Christoph I.
N1 - Funding Information:
We thank the participating women, facilities, and radiologists for the data they have provided. A list of BCSC investigators is provided at www.bcsc-research.org The collection of cancer and vital status data used in this study was supported, in part, by several state public health departments and cancer registries throughout the United States. For a full description of these sources, please see www.bcsc-research.org/work/acknowledgment.html. This work was supported by grants from the National Cancer Institute (for the BCSC, P01CA154292) and the ACS (MRSG-14-160-01-CPHPS). The content is solely the responsibility of the authors and does not represent the official views of the National Cancer Institute, National Institutes of Health, or the ACS.
Funding Information:
All authors report no financial conflicts of interest related to this work. Drs. C.I. Lee, Lehman, and J.M. Lee report grant funding from GE Healthcare unrelated to this work.
Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc. 2018.
PY - 2018/6
Y1 - 2018/6
N2 - Background: Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection. Materials and Methods: We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use. Results: Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74). Conclusions: While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.
AB - Background: Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection. Materials and Methods: We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use. Results: Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74). Conclusions: While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.
KW - breast cancer, high-risk screening, supplemental breast MRI, access, disparities
UR - http://www.scopus.com/inward/record.url?scp=85048667347&partnerID=8YFLogxK
U2 - 10.1089/jwh.2017.6623
DO - 10.1089/jwh.2017.6623
M3 - Article
C2 - 29341851
AN - SCOPUS:85048667347
SN - 1540-9996
VL - 27
SP - 748
EP - 754
JO - Journal of Women's Health
JF - Journal of Women's Health
IS - 6
ER -