AR: Few high-risk women follow through with breast MR
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| Breast MRI navigation software. Source: Sentinelle Medical |
“It’s hard to tell where, exactly, is the disconnect,” Deborah Glueck, PhD, investigator at the University of Colorado Cancer Center in Denver, said in a statement.
In 2007, the American Cancer Society (ACS) recommended that women at an elevated risk for breast cancer undergo breast MRI screening as an adjunct to mammography.
After the ACS recommendation, Denver-based Invision provided risk assessment to all women presenting for screening mammography and recommended to primary care providers that women with a 20 percent or higher risk receive breast MRI screening exam.
John T. Brinton, MS, from the department of biostatistics and informatics at University of Colorado, and colleagues designed a prospective cohort study to estimate the proportion of women presenting for screening mammography at 20 percent or greater lifetime risk for breast cancer based on the Gail model. The researchers also reported on the proportion of women who complied with the breast MRI recommendation.
The study population included 64,659 women who presented for screening mammography between January 8, 2008, and January 7, 2009.
The clinic estimated risk by determining which women had a first-degree maternal relative with breast cancer. These women were asked to provide additional data as inputs for the Gail model of risk assessment: previous history of biopsy, age, age at menarche, age at first live birth, number of female relatives with breast cancer, number of previous breast biopsies, prior diagnosis with atypical hyperplasia and race.
The results were used to inform the recommendation for screening MRI.
A total of 10,788 women were evaluated using the Gail model, according to Brinton and colleagues. Among this group, 1,246 women had a lifetime risk of breast cancer of 20 percent or greater and recommendations for MR screening were provided to their primary care providers.
“Of those women, 173 had a screening breast MRI within one year of the recommendation at the same clinic where the initial screening and risk assessment took place,” wrote Brinton and colleagues.
“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,” Glueck said.
In addition to the questions Glueck posed, the researchers acknowledged additional limitations of the study, including its single-site design.
Since the study, Invision has updated its protocols and plans to switch from the Gail model for risk assessment to the Tyrer-Cuzick model, which accounts for history of cancer in second-degree relatives, for all patients. The clinic also communicates recommendations for breast MRI screening directly to women with a 20 percent or greater lifetime risk, in addition to their primary care physicians.
Finally, researchers have planned a follow-up study and will attempt to determine if informing high-risk women directly about the breast screening MRI recommendation will improve screening adherence.