High-risk breast cancer patients avoid MRIs that could improve early detection of disease

Nearly half of women at a high lifetime risk for breast cancer undergo routine mammograms at practices with onsite breast MR imaging capabilities, but MRI screenings are being vastly underused in the population, reaching just 6.6 percent of high-risk patients, a study in the Journal of Women’s Health states.

Earlier studies have shown the efficacy of an additional breast MRI in detecting cancer—notably smaller, node-negative tumors—in women at a high lifetime risk for breast cancer, Randy C. Miles, MD, and co-authors wrote. But patients and their clinicians aren’t taking advantage of the imaging tool, even when the tech is at their fingertips.

“While mammography is the only modality proven to reduce breast cancer-specific mortality, it demonstrates reduced performance in certain subpopulations of women at increased risk,” Miles and colleagues said. “Early detection of potentially curable cancers is of particular interest among high-risk women, whose cancers develop at an earlier age, grow at a more rapid rate and have diminished response to therapy compared to women at average risk.”

The authors performed a cross-sectional study of 422,406 women undergoing routine mammography screenings in 2012, noting which facilities had onsite screening breast MRI services. But even though 43.9 percent of women at the highest risk for developing breast cancer—those with a 20 percent or greater absolute lifetime risk—attended practices with onsite MRI machines, less than 10 percent underwent the screening process.

Women were more likely to undergo additional MR imaging if they were under 40 years old, had a family history of breast cancer, had a prior breast biopsy or if they completed postsecondary education.

“While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with onsite breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection,” Miles et al. wrote. “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.”