Patients with High Breast Cancer Risk Not Receiving MRI Screening

Numerous factors, including genetics and environmental exposure, can increase the risk of breast cancer. Patients with a high risk of the disease are recommended to receive more stringent screenings, including breast magnetic resonance imaging (MRI) scans.

A new study presented at the American College of Surgeons Clinical Congress 2017 suggests that many women with a high risk of breast cancer may not be receiving MRI screening, even when the scan was free and recommended by a health care provider.

“The military health system is an equal access, no cost system. This system allows us to study how well we are doing in terms of truly adhering to the current recommended guidelines for screening of breast cancer,” said lead study author Vance Sohn, MD.

Included in the study were data from 1057 women in the military health care system who had a breast cancer risk of at least 20%. MRI screenings were offered based on risk between 2015 and 2016. The authors noted that only 23% of patients underwent the exam.

Specifically, only 15% of patients with a 20% to 24% risk of breast cancer and 24% of patients with a 25% to 29% received the test, according to the study. Additionally, 36% of patients with a 30% to 39% risk and 50% of patients with more than a 40% risk underwent the screening.

These findings suggest that there are significant gaps in screening high-risk patients for breast cancer, according to the study authors.

“In the interest of helping more women be screened earlier for breast cancer, we were intrigued about what this preliminary study identified—that 85% of women with a 20% to 24% lifetime risk still did not pursue high risk surveillance,” Dr Sohn said. “Ultimately, the question we are really trying to answer is why women at high risk for breast cancer are declining MRI screening. That issue is the next phase of this study.”

In future studies, the authors said they plan to determine why patients declined to receive the free screening to uncover potential ways to increase MRI scans.

“If we understand the reason behind this circumstance, it will help us better target those who would benefit from this imaging modality so we could provide clear explanations about the test,” Dr Sohn said. “The general sense is that patients are just too busy, but discovering the reason will be a very important piece to this puzzle.”

While all patients included were in the military health system, the authors hypothesize that the results may be similar for the general public.

“In fact, I imagine our compliance rate is even higher than most. Within the civilian health care system, there are fiscal implications such as the cost of the MRI and future health insurance implications, that we are controlling for,” Dr Sohn said.

Unnecessary breast cancer screening can cause anxiety and additional testing that may not be appropriate. Health care providers and patients must understand the benefits and risks associated with MRI screening to develop a customized screening plan, according to the study.

“So maybe the 20% to 24% lifetime risk isn’t really appropriate, maybe it should be even higher than what the organizations are recommending. In other words, what is the appropriate cutoff? Ultimately, that is really what we are trying to decipher,” Dr Sohn concluded.