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Original Investigation |

Rapid Increase in Breast Magnetic Resonance Imaging Use:  Trends From 2000 to 2011

Natasha K. Stout, PhD1; Larissa Nekhlyudov, MD, MPH1,2; Lingling Li, PhD1; Elisabeth S. Malin, MS3; Dennis Ross-Degnan, ScD1; Diana S. M. Buist, PhD4; Marjorie A. Rosenberg, PhD5,6; Marina Alfisher, MD7; Suzanne W. Fletcher, MD, MSc1
[+] Author Affiliations
1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
2Department of Medicine, Harvard Vanguard Medical Associates, Boston, Massachusetts
3Massachusetts General Hospital, Boston
4Group Health Research Institute, Seattle, Washington
5Department of Actuarial Science, Risk Management and Insurance, University of Wisconsin, Madison
6Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
7Department of Radiology, Harvard Vanguard Medical Associates, Boston, Massachusetts
JAMA Intern Med. 2014;174(1):114-121. doi:10.1001/jamainternmed.2013.11958.
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Importance  Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. How breast MRI is actually used in community settings is unknown.

Objective  To describe breast MRI trends and indications in a community setting.

Design, Setting, and Participants  Retrospective cohort study at a not-for-profit health plan and multispecialty group medical practice in New England of 10 518 women aged 20 years and older enrolled in the health plan for at least 1 year who had at least 1 breast MRI between January 1, 2000, and December 31, 2011.

Main Outcomes and Measures  Breast MRI counts were obtained from claims data. Clinical indication (screening, diagnostic evaluation, staging or treatment, or surveillance) was determined using a prediction model developed from electronic medical records on a subset of participants. Breast cancer risk status was assessed using claims data and, for the subset, also through electronic medical record review.

Results  Breast MRI use increased more than 20-fold from 6.5 per 10 000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10 000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening.

Conclusions and Relevance  Breast MRI use increased steeply over 10 years and then stabilized, especially for screening and surveillance among women with family or personal history of breast cancer; most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting ACS criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most.

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Figure.
Rates of Breast Magnetic Resonance Imaging (MRI) Use, 2000 Through 2011

A, Age-specific rates. Each bar within an age group represents a calendar year. B, Indication-specific rates for 4 primary indications: screening, diagnostic, staging or treatment, and surveillance.

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