Utilization of breast cancer screening with magnetic resonance imaging in community practice
Background Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of scr...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2018-03, Vol.33 (3), p.275-283 |
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| creator | Hill, Deirdre A. Haas, Jennifer S. Wellman, Robert Hubbard, Rebecca A. Lee, Christoph I. Alford-Teaster, Jennifer Wernli, Karen J. Henderson, Louise M. Stout, Natasha K. Tosteson, Anna N. A. Kerlikowske, Karla Onega, Tracy |
| description | Background
Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice.
Objective
To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications.
Design
Prospective cohort study conducted between 2007 and 2014.
Participants
In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI.
Main measures
Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression.
Key results
Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7–2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9–14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0–60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%–84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1–37.9%) among women considered at low-to-average breast cancer risk.
Conclusion
Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care. |
| doi_str_mv | 10.1007/s11606-017-4224-6 |
| format | Article |
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Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice.
Objective
To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications.
Design
Prospective cohort study conducted between 2007 and 2014.
Participants
In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI.
Main measures
Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression.
Key results
Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7–2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9–14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0–60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%–84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1–37.9%) among women considered at low-to-average breast cancer risk.
Conclusion
Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-017-4224-6</identifier><identifier>PMID: 29214373</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Breast cancer ; Breasts ; Cancer ; Cancer screening ; Communities ; Confidence intervals ; Consortia ; Genetics ; Guidelines ; Health risk assessment ; Health risks ; Internal Medicine ; Magnetic resonance imaging ; Mammography ; Medical screening ; Medicine ; Medicine & Public Health ; NMR ; Nuclear magnetic resonance ; Original Research ; Poisson density functions ; Resonance ; Risk assessment ; Risk factors ; Statistical analysis ; Utilization</subject><ispartof>Journal of general internal medicine : JGIM, 2018-03, Vol.33 (3), p.275-283</ispartof><rights>Society of General Internal Medicine 2017</rights><rights>Journal of General Internal Medicine is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-30420bf40d09a15a8147b3fca86f260df74370de113f1a0d33a9d1ae25e53d6a3</citedby><cites>FETCH-LOGICAL-c470t-30420bf40d09a15a8147b3fca86f260df74370de113f1a0d33a9d1ae25e53d6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834962/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834962/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29214373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hill, Deirdre A.</creatorcontrib><creatorcontrib>Haas, Jennifer S.</creatorcontrib><creatorcontrib>Wellman, Robert</creatorcontrib><creatorcontrib>Hubbard, Rebecca A.</creatorcontrib><creatorcontrib>Lee, Christoph I.</creatorcontrib><creatorcontrib>Alford-Teaster, Jennifer</creatorcontrib><creatorcontrib>Wernli, Karen J.</creatorcontrib><creatorcontrib>Henderson, Louise M.</creatorcontrib><creatorcontrib>Stout, Natasha K.</creatorcontrib><creatorcontrib>Tosteson, Anna N. A.</creatorcontrib><creatorcontrib>Kerlikowske, Karla</creatorcontrib><creatorcontrib>Onega, Tracy</creatorcontrib><title>Utilization of breast cancer screening with magnetic resonance imaging in community practice</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice.
Objective
To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications.
Design
Prospective cohort study conducted between 2007 and 2014.
Participants
In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI.
Main measures
Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression.
Key results
Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7–2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9–14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0–60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%–84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1–37.9%) among women considered at low-to-average breast cancer risk.
Conclusion
Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care.</description><subject>Breast cancer</subject><subject>Breasts</subject><subject>Cancer</subject><subject>Cancer screening</subject><subject>Communities</subject><subject>Confidence intervals</subject><subject>Consortia</subject><subject>Genetics</subject><subject>Guidelines</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Internal Medicine</subject><subject>Magnetic resonance imaging</subject><subject>Mammography</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Original Research</subject><subject>Poisson density functions</subject><subject>Resonance</subject><subject>Risk assessment</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Utilization</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU9rFTEUxYMo9rX1A7iRgBs3Y-9NMpOZjSBFrVDoxu4KIS9z5zVlJnkmM0r99GZ4tf4BV4Gc3z05N4exlwhvEUCfZcQGmgpQV0oIVTVP2AZrUVeoOv2UbaBtVdVqqY7Ycc53ACiFaJ-zI9EJVFLLDbu5nv3of9jZx8DjwLeJbJ65s8FR4tklouDDjn_38y2f7C7Q7B1PlGNYEe7L3ar7wF2cpiX4-Z7vk3UFo1P2bLBjphcP5wm7_vjhy_lFdXn16fP5-8vKKQ1zJUEJ2A4Keugs1rZFpbdycLZtBtFAP-iSFXpClANa6KW0XY-WRE217BsrT9i7g-9-2U7UOwpzsqPZp5Iu3ZtovflbCf7W7OI3U7dSdY0oBm8eDFL8ulCezeSzo3G0geKSDXZaAUCrVEFf_4PexSWFsp4R5YM77ECuhnigXIo5JxoewyCYtTtz6M6U7szanWnKzKs_t3ic-FVWAcQByEUKO0q_n_6_60-MaKXW</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Hill, Deirdre A.</creator><creator>Haas, Jennifer S.</creator><creator>Wellman, Robert</creator><creator>Hubbard, Rebecca A.</creator><creator>Lee, Christoph I.</creator><creator>Alford-Teaster, Jennifer</creator><creator>Wernli, Karen J.</creator><creator>Henderson, Louise M.</creator><creator>Stout, Natasha K.</creator><creator>Tosteson, Anna N. A.</creator><creator>Kerlikowske, Karla</creator><creator>Onega, Tracy</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180301</creationdate><title>Utilization of breast cancer screening with magnetic resonance imaging in community practice</title><author>Hill, Deirdre A. ; Haas, Jennifer S. ; Wellman, Robert ; Hubbard, Rebecca A. ; Lee, Christoph I. ; Alford-Teaster, Jennifer ; Wernli, Karen J. ; Henderson, Louise M. ; Stout, Natasha K. ; Tosteson, Anna N. A. ; Kerlikowske, Karla ; Onega, Tracy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-30420bf40d09a15a8147b3fca86f260df74370de113f1a0d33a9d1ae25e53d6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Breast cancer</topic><topic>Breasts</topic><topic>Cancer</topic><topic>Cancer screening</topic><topic>Communities</topic><topic>Confidence intervals</topic><topic>Consortia</topic><topic>Genetics</topic><topic>Guidelines</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Internal Medicine</topic><topic>Magnetic resonance imaging</topic><topic>Mammography</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Original Research</topic><topic>Poisson density functions</topic><topic>Resonance</topic><topic>Risk assessment</topic><topic>Risk factors</topic><topic>Statistical analysis</topic><topic>Utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hill, Deirdre A.</creatorcontrib><creatorcontrib>Haas, Jennifer S.</creatorcontrib><creatorcontrib>Wellman, Robert</creatorcontrib><creatorcontrib>Hubbard, Rebecca A.</creatorcontrib><creatorcontrib>Lee, Christoph I.</creatorcontrib><creatorcontrib>Alford-Teaster, Jennifer</creatorcontrib><creatorcontrib>Wernli, Karen J.</creatorcontrib><creatorcontrib>Henderson, Louise M.</creatorcontrib><creatorcontrib>Stout, Natasha K.</creatorcontrib><creatorcontrib>Tosteson, Anna N. A.</creatorcontrib><creatorcontrib>Kerlikowske, Karla</creatorcontrib><creatorcontrib>Onega, Tracy</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hill, Deirdre A.</au><au>Haas, Jennifer S.</au><au>Wellman, Robert</au><au>Hubbard, Rebecca A.</au><au>Lee, Christoph I.</au><au>Alford-Teaster, Jennifer</au><au>Wernli, Karen J.</au><au>Henderson, Louise M.</au><au>Stout, Natasha K.</au><au>Tosteson, Anna N. A.</au><au>Kerlikowske, Karla</au><au>Onega, Tracy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utilization of breast cancer screening with magnetic resonance imaging in community practice</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>33</volume><issue>3</issue><spage>275</spage><epage>283</epage><pages>275-283</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice.
Objective
To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications.
Design
Prospective cohort study conducted between 2007 and 2014.
Participants
In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI.
Main measures
Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression.
Key results
Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7–2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9–14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0–60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%–84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1–37.9%) among women considered at low-to-average breast cancer risk.
Conclusion
Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29214373</pmid><doi>10.1007/s11606-017-4224-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | SpringerLink Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Breast cancer Breasts Cancer Cancer screening Communities Confidence intervals Consortia Genetics Guidelines Health risk assessment Health risks Internal Medicine Magnetic resonance imaging Mammography Medical screening Medicine Medicine & Public Health NMR Nuclear magnetic resonance Original Research Poisson density functions Resonance Risk assessment Risk factors Statistical analysis Utilization |
| title | Utilization of breast cancer screening with magnetic resonance imaging in community practice |
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