Breast MRI use on the rise, but is it being used appropriately?

The use of breast MRI has increased over the last decade, but two studies published online in JAMA Internal Medicine question whether these examinations are being administered appropriately.

According to one retrospective study, of 10,518 women who underwent breast MRI in New England, breast MRI scans increased from 6.5 scans per 10,000 women in 2000 to 130.7 scans per 10,000 women by 2009; that number declined to 104.8 scans per 10,000 women in 2011.

In the group of women studied who had electronic medical records, just 21 percent had evidence of meeting American Cancer Society criteria for breast screening. On the other hand, 48.4 percent of women with documented genetic mutations were screened.

The other study also documented an increase in the use of breast MRI in community practice and determined that while women at average risk were receiving MRI screening, women at high risk were not receiving MRI screening.

In a commentary accompanying the articles, E. Shelley Hwang of Duke University Medical Center and Isabelle Bedrosian of MD Anderson Cancer Center wrote that while the two studies covered different populations and used different methodologies, the findings are "remarkably consistent." What is most striking about the two studies is that breast MRI was both overused in women not meeting guideline criteria and underused in those who could derive greatest benefit."

Consequently, they wrote, the data shows there is a need for improved patient selection for breast MRI if it is going to be "maximally effective." They also pointed out that the current focus on healthcare cost containment means that the appropriate use of MRI is going to be of concern considering its high cost. For example, reimbursement levels from Medicare and Medicaid range from $880 to about $1,600 for MRIs of both breasts, compared to $300 for a digital mammogram.

In a Reuters Health article, Hwang noted that the number of breast MRI exams began to level off around 2008, demonstrating that physicians were quick to adopt breast MRI as a new technology, but began to reduce utilization once organization began developing imaging guidelines.

"It wasn't really until the guidelines came along when people started dialing back on using them in the less beneficial situations," she said.

In the same article, Harvard Medical School's Natasha Stout, who served as lead author on the first study, said that it would be important to continue monitoring who was using breast MRI and why "to make sure we are using this expensive technology wisely."

To learn more:
- see the study by Stout and colleagues
- check out the other JAMA Internal Medicine study
- read the commentary in JAMA Internal Medicine
- see the Reuters Health article

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