A study of 64,659 women found that while 1,246 of these women were at high enough breast cancer risk to recommend additional screening with magnetic resonance imaging (MRI), only 173 of these women returned to the clinic within one year for the further screening.

The study’s findings were published in the January 2012 issue in the journal Academic Radiology. “It’s hard to tell where, exactly, is the disconnect,” said Deborah Glueck, PhD, an investigator from the University of Colorado Cancer Center (Denver, CO, USA) and associate professor of biostatistics and informatics at the Colorado School of Public Health, the article’s senior author.

But no matter the discrepancy, the result is unambiguous: women who should be getting breast screening MRI are not.

Along with her PhD student, John Brinton, Dr. Glueck got interested in the data of MRI breast screening soon after the 2007 recommendation by the American Cancer Society (Atlanta, GA, USA) that women at increased lifetime risk for developing breast cancer be screened with MRI in addition to annual mammograms. In fact, in spite of most major U.S. health insurances offering coverage, few clinics put the recommendation into practice.
An exception is Invision Sally Jobe Breast Centers (Denver, CO, USA). “The Invision Sally Jobe Breast Centers and our collaborators, Dr. Lora Barke, Mary Freivogel, and Stacy Jackson have been invaluable partners in our research,” Dr. Glueck said.

At Invision Sally Jobe, clinicians were using the US National Cancer Institute’s (Bethesda, MD, USA) Gail Model to identify a patient’s lifetime risk of developing breast cancer. For women with greater than 20% lifetime risk, the clinic included in the mammography findings that were sent to women’s primary care physicians a note explaining the elevated risk and suggesting that the physician refer high-risk women for the recommended MRI. “Did women never hear the recommendation from their physician? Did they choose not to follow through? Did they go elsewhere for an MRI? We don’t know,” Dr. Glueck remarked.

Thus, major questions remain in the assessment of the benefit, feasibility, and implementation of breast MRI screening. According to Drs. Glueck and Brinton, the most essential and all-encompassing of these questions is whether the benefits of MRI screening for women at high risk for breast cancer, in fact, outweigh its high financial, medical, and psychologic costs.
“For this to be true, first MRI has to catch breast cancer sooner than traditional mammography, it has to catch cancers that would otherwise kill, it has to catch cancers for which early treatment is more effective than later treatment, and the medical and psychologic downsides in the process of screening and follow-up care--for example, the potential for increased biopsies--have to be lower than the medical positives,” Dr. Glueck said.

Follow-up studies should help answer these questions, including a planned study in which the researchers will see if informing high-risk women directly about the breast screening MRI recommendation will improve screening adherence. However, considerable obstacles remain between the hypothesis that shows survival benefit for breast screening MRI in high-risk women and its practice, according to the investigators.
 

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