Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status

Abstract

Background Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities. Methods Among 316,172 women aged 35-69 years from five Breast Cancer Surveillance Consortium registries (2007-2012), we examined 617,723 negative screening mammograms and 1,047 screening MRIs. We examined the relative risks (RRs) of MRI use by women with <20% lifetime breast cancer risk and RR in the absence of MRI use by women with ≥20% lifetime risk. Results Among women with <20% lifetime risk, non-Hispanic white women were 62% more likely than non-white women to receive a MRI (95% confidence interval 1.32-1.98). Of these women, those with some college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared to those with a high school education or less. Among women with ≥20% lifetime risk, there was no statistically significant difference in use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to receive screening MRI than women who had graduated from college (RR 0.40; 95% CI 0.25-0.63). Conclusions Uptake of screening breast MRI into clinical practice has the potential to worsen population-based health disparities. Policies, beyond health insurance coverage, should ensure that use of this screening modality reflects evidence-based guidelines.

Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk

“…Our study builds on findings by Haas et al, 25 who reported a positive association between advanced education and uptake of supplemental MRI screening services over time. Higher educational attainment may increase personal perception of risk based on family history, which may encourage women in this group to discuss risk reduction with healthcare providers.…”

“…Higher educational attainment may increase personal perception of risk based on family history, which may encourage women in this group to discuss risk reduction with healthcare providers. 25 Prior studies have also suggested disparities among traditionally underserved groups in gaining access to genetic risk assessment, which may directly impact referral for supplemental breast screening. 26 We found no significant difference in on-site MRI use between women who resided in areas with low household income levels compared to women with higher income levels.…”

Performance Benchmarks for Screening Breast MR Imaging in Community Practice

“…Use of advanced imaging techniques such as breast MR imaging has the potential to exacerbate existing disparities in access to breast cancer screening and diagnostic services. Previous BCSC analyses showed that, among women at high risk, those with lower educational attainment (high school graduate, General Educational Development certificate of high school equivalency, or lower) were 60% less likely to use screening MR imaging compared with women with at least a college degree (25). At the same time, among women at average risk, those with at least a college education were almost 2.5 times more likely to use screening MR imaging.…”

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types

“…50 Third, studies have found that risk among black patients receiving delayed and nonstandard treatment is substantially elevated. 51,52 Nevertheless, white women tend to have magnetic resonance imaging targeting breast cancer and genetic testing of high sensitivity. Moreover, they also undergo more aggressive preventive procedures, such bilateral mastectomies, which greatly improve their survival outcomes.…”