Use of Breast MRI Increasingly Aligned with Most Effective Care
March 26, 2014
Magnetic resonance imaging (MRI) is increasingly used for breast cancer screening, diagnostic evaluation, treatment planning, and surveillance, but a recent study published in JAMA Internal Medicine, "Patterns of Breast Magnetic Resonance Imaging Use in Community Practice," found that the indication for breast MRI has changed over time. Much of the increase was found among women with breast cancer risk factors, but there are still notable gaps in risk-based use.
Tracy L. Onega, PhD, associate professor of Community and Family Medicine and of the Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Norris Cotton Cancer Center member, was a co-author on the paper. The findings suggest the continued need for evidence that will help align use of breast MRI, mammography, and newer imaging technologies like digital breast tomosynthesis with the most effective care.
The study used data on breast MRI and mammography collected by five national Breast Cancer Surveillance Consortium registries from 2005 to 2009 – including the New Hampshire Mammography Network. It included 8,931 breast MRI examinations and 1,288,924 screening mammograms from women aged 18 to 79 years. Researchers found that in this period the overall rate of breast MRI nearly tripled. The most common clinical indication was diagnostic evaluation (40.3 percent), followed by screening (31 percent).
"The benefit of breast MRI includes high sensitivity for identifying breast malignancy, and national guidelines support using it for particular clinical indications," said Onega. "But compared to mammography, breast MRI is more expensive and can lead to higher false positive rates. We need to continue to evaluate and compare the effectiveness of how MRI and mammography are used and find ‘the right test for the right woman at the right time'."
The collaborators on this study, investigators within the Breast Cancer Surveillance Consortium (BCSC), include the following authors: Karen J. Wernli PhD; Wendy B. DeMartini MD; Laura Ichikawa MS; Constance D. Lehman MD, PhD; Tracy Onega PhD; Karla Kerlikowske MD, MS; Louise M. Henderson PhD; Berta M. Geller EdD; Mike Hofmann, Bonnie C. Yankaskas PhD, for the Breast Cancer Surveillance Consortium.
This work was supported by the National Cancer Institute-funded Breast Cancer Surveillance Consortium co-operative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040) and the National Cancer Institute-funded grants RC2CA148577 and P01 CA154292. The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: http://breastscreening.cancer.gov/work/acknowledgement.html. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at: http://breastscreening.cancer.gov/. In addition, Dr. Wernli was supported in part by the Agency for Healthcare Research and Quality (K12 HS019482).
About Norris Cotton Cancer Center at Dartmouth-Hitchcock
Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.