Study Finds Room for Improvement in Use of Breast MRI

The rate of women receiving breast MRI nearly tripled from 2005 to 2009, according to the results of a large national study.

During that 4-year span, the overall rate of breast MRI jumped from 4.2 to 11.5 examinations per 1,000 women, with the most rapid increase occurring from 2005 to 2007 (P = .02), the researchers found using data collected from 5 national Breast Cancer Surveillance Consortium registries. The researchers included data on 8,931 breast MRI examinations and 1,288,924 screening mammograms from women aged 18 to 79 years.

The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31.7%).

While the researchers were pleased with the increased use of MRI, they said that more could be done to improve its appropriate use among women who could benefit from the practice.

"We found that use of breast MRI for breast cancer screening-rather than diagnosis-is rising, as is appropriate," said lead author Karen Wernli, PhD, assistant professor of health services at the University of Washington School of Public Health and an assistant investigator at Group Health Research Institute, in a news release.

Compared with women who only received screening mammography, those women who had a screening breast MRI were more likely to be younger than 50 years, white non-Hispanic, and nulliparous and to have a personal history of breast cancer, a family history of breast cancer, and extremely dense breast tissue.

However, the authors found room for improvement in the use of breast MRI, noting that most of the women at high lifetime risk for breast cancer-who could most likely benefit from breast MRI-appeared not to be using it yet. Meanwhile, many women at average risk for breast cancer were screened using breast MRI, even though mammography is still considered the best screening test for them, they found.

"To prevent the underuse by women at high risk and overuse by those at average risk," Wernli said, "we need to strengthen the network of providers, like genetic counselors, who can provide women with the breast cancer risk counseling that they need."

Still, the proportion of women at high lifetime risk for breast cancer who were screened using breast MRI (>20%) also increased during the study period, from 9% in 2005 to 29% in 2009.

Pertinent Points:
- The rate of women receiving breast MRI nearly tripled from 2005 to 2009.
- The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31.7%).
- The authors suggest that more education is needed to ensure breast MRI is being used appropriately among women of varying risk factors for breast cancer.

References:

Wernli KJ, DeMartini WB, Ichikawa l, et al, for the Breast Cancer Surveillance Consortium. Patterns of breast magnetic resonance imaging use in community practice. JAMA Intern Med. 2013;doi:10.1..1/jamainternmed.2013.11963.