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Breast MRI use increased, but not always in appropriate populations

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The use of breast MRI increased more than 20-fold between 2000 and 2009, but the majority of women who underwent the procedure did not meet American Cancer Society criteria, according to study results.

In addition, a considerable percentage of women who met appropriate use criteria for breast MRI did not undergo the procedure.

Details on the use of breast MRI in a community setting are unknown. Researchers conducted the current study to identify the trends associated with breast MRI use at a not-for-profit health plan and multispecialty group medical practice in New England.

The analysis included 10,518 women aged 20 years and older enrolled in the health plan for at least 1 year. All women underwent at least one breast MRI between Jan. 1, 2000 and Dec. 31, 2011.

The researchers determined the rate of breast MRI increased from 6.5 per 10,000 women in 2000 to 130.7 per 10,000 women in 2009. The rate then leveled off and, by 2011, it declined slightly to 104.8 per 10,000 women.

By 2011, screening and surveillance accounted for 57.6% of breast MRI use. Of these women, 30.1% had a claims-documented personal history, 51.7% had a family history of breast cancer and 3.5% had a documented genetic mutation.

Of women with electronic health records who underwent screening or surveillance MRI, only 21% met American Cancer Society criteria for breast MRI, researchers wrote. Conversely, only 48.4% of women with documented deleterious genetic mutations underwent breast MRI screening.

 

E. Shelley Hwang

“Most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting American Cancer Society criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most,” the researchers wrote.

A “thoughtful data-driven allocation of technology” is necessary for clinicians and patients to make the best choices, E. Shelley Hwang, MD, MPH, a professor of surgery in the division of surgical oncology at Duke University School of Medicine, and Isabelle Bedrosian, MD, associate professor in the division of surgery at The University of Texas MD Anderson Cancer Center, wrote in an accompanying editorial.

“As a medical community, we bear a collective responsibility to ensure that breast MRI provides sufficient clinical benefit to warrant the additional biopsies, increased patient anxiety and cost that accrue with its use,” Hwang and Bedrosian wrote.

For more information:

• Hwang ES. JAMA Intern Med. 2014; 174:122-124.
• Stout NK. JAMA Intern Med. 2014;174:114-121.

Disclosure: The researchers report no relevant financial disclosures.