Breast imaging referrers ordering more MRI scans following legislation

Referring physicians who have the option to send women for breast MRI are unclear on the exam’s clinical usefulness. That goes for specialists as well as primary-care providers. However, at an academic hospital system in Boston, all referring providers have been ordering more breast MRI since Massachusetts began requiring mammographers to inform patients in writing of their breast density.

So found breast radiologists at Beth Israel Deaconess Medical Center when they surveyed their referral base. The Harvard researchers had their findings published online in The Breast.  

Senior author Vandana Dialani, MD, and colleagues received completed surveys from 134 ordering providers of 525 on their distribution list (a 26 percent response rate).

Reviewing the responses, they found 42 percent (n = 57) order breast MRI in practice, most commonly for high-risk screening (84 percent).

At the same time, 79 percent of MRI-comfortable referrers (n = 45) order fewer than 10 exams per year.

Referrers who don’t order breast MRI collectively identified lack of familiarity as the most consistent reason (32 of 77, or 42 percent).

Primary-care docs order breast MRI less frequently than specialists, yet both have mixed perceptions of the clinical utility of breast MRI, the authors reported.

Despite the widespread reticence, some 30 percent of survey respondents said they’ve ordered more breast MRI since the January 2015 enactment of legislation mandating density notification in the Bay State.

Additionally, 29 percent indicated they would order breast MRI more often to screen women with dense breasts if there was a low-cost option.

“Our study suggests a growing clinical interest in breast MRI for screening; however, there is a need for provider education on the clinical utility of breast MRI,” the authors wrote. “Increasing the radiologist’s role in targeted educational interventions may help improve awareness and lead to more appropriate utilization of resources.”