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Original Investigation |

Patterns of Breast Magnetic Resonance Imaging Use in Community Practice

Karen J. Wernli, PhD1; Wendy B. DeMartini, MD2; Laura Ichikawa, MS1; Constance D. Lehman, MD, PhD2; Tracy Onega, PhD3; Karla Kerlikowske, MD, MS4,5,6; Louise M. Henderson, PhD7; Berta M. Geller, EdD8,9; Mike Hofmann, MS5; Bonnie C. Yankaskas, PhD7 ; for the Breast Cancer Surveillance Consortium
[+] Author Affiliations
1Group Health Research Institute, Seattle, Washington
2Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
3Department of Community and Family Medicine, Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire
4General Internal Medicine Section, Department of Veterans Affairs, San Francisco, California
5Department of Medicine, University of California, San Francisco
6Department of Epidemiology and Biostatistics, University of California, San Francisco
7Department of Radiology, University of North Carolina, Chapel Hill
8Department of Family Medicine, University of Vermont, Burlington
9Department of Radiology, University of Vermont, Burlington
JAMA Intern Med. 2014;174(1):125-132. doi:10.1001/jamainternmed.2013.11963.
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Importance  Breast magnetic resonance imaging (MRI) is increasingly used for breast cancer screening, diagnostic evaluation, and surveillance. However, we lack data on national patterns of breast MRI use in community practice.

Objective  To describe patterns of breast MRI use in US community practice during the period 2005 through 2009.

Design, Setting, and Participants  Observational cohort study using data collected from 2005 through 2009 on breast MRI and mammography from 5 national Breast Cancer Surveillance Consortium registries. Data included 8931 breast MRI examinations and 1 288 924 screening mammograms from women aged 18 to 79 years.

Main Outcomes and Measures  We calculated the rate of breast MRI examinations per 1000 women with breast imaging within the same year and described the clinical indications for the breast MRI examinations by year and age. We compared women screened with breast MRI to women screened with mammography alone for patient characteristics and lifetime breast cancer risk.

Results  The overall rate of breast MRI from 2005 through 2009 nearly tripled from 4.2 to 11.5 examinations per 1000 women, with the most rapid increase from 2005 to 2007 (P = .02). The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31.7%). Compared with women who received screening mammography alone, women who underwent screening breast MRI were more likely to be younger than 50 years, white non-Hispanic, and nulliparous and to have a personal history of breast cancer, a family history of breast cancer, and extremely dense breast tissue (all P < .001). The proportion of women screened using breast MRI at high lifetime risk for breast cancer (>20%) increased during the study period from 9% in 2005 to 29% in 2009.

Conclusions and Relevance  Use of breast MRI for screening in high-risk women is increasing. However, our findings suggest that there is a need to improve appropriate use, including among women who may benefit from screening breast MRI.

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Figure.
Temporal Trends in Breast Magnetic Resonance Imaging (MRI) Rates per 1000 Women Overall and by Clinical Indication, 2005-2009

Data from the Breast Cancer Surveillance Consortium. Rate calculated as the total number of breast MRI examinations by indication divided by the total number of women with breast imaging conducted during the same year.

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