Even when common barriers to access such as cost are removed from breast MRI screening, many women with a higher lifetime risk of breast cancer still decline MRI scans, according to research presented at the American College of Surgeons Clinical Congress in San Diego.
Women with more than a 20% risk of breast cancer -- due to genetic predisposition to the disease or a personal or family history of it -- are recommended to undergo yearly breast MRI screening, according to a team led by Dr. Vance Sohn from Madigan Army Medical Center in Tacoma, WA. But Sohn and colleagues found that most women offered MRI at Madigan chose not to have it, even though it was free.
"The military health system is an equal access, no-cost system," Sohn said in a statement released by the American College of Surgeons. "This allows us to study how well we are doing in terms of truly adhering to the current recommended guidelines for screening of breast cancer."
The researchers analyzed data from 1,057 women who had at least a 20% greater lifetime risk of developing breast cancer. The women also were offered breast MRI screening based on their high-risk status, not mammography results, between 2015 and 2016.
Only 247 women, or 23%, underwent breast MRI screening. Further analysis by risk level is shown in the table below.
| Women who underwent breast MRI, according to risk level | |
| Lifetime risk of breast cancer | Percent who had MRI |
| 20%-24% | 15% |
| 25%-29% | 24% |
| 30%-39% | 36% |
| ≥ 40% | 50% |
Although the study was conducted at a military health system, the findings are not likely unique to the military, Sohn said.
"In fact, I imagine our compliance rate is even higher than most," he said. "Within the civilian healthcare system, there are fiscal implications such as the cost of the MRI and future health insurance implications."
The researchers plan to explore why women at higher risk for breast cancer are declining MRI.
"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," 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."
