Researchers determine why high-risk breast cancer patients refuse MRIs

Almost half of the women who are eligible for breast cancer screening with MRI refuse to undergo the procedure, according to researchers at Johns Hopkins.

To gauge patient acceptance of MRI as a breast screen tool, Wendie A. Berg, MD, PhD, breast imaging specialist at American Radiology Services, Johns Hopkins-Green Spring Station in Lutherville, MD, and colleagues studied 1,215 eligible women at intermediate or high risk for breast cancer who were offered a contract-enhanced screening MRI exam. Of these women, only 57.9% agreed to the exam and only 51.6% completed the exam per protocol. 

“Given that MRI is promoted as a very sensitive test to identify early breast cancer, we were surprised that barely half of women at increased risk for breast cancer would undergo MRI even when offered at no cost,” said Dr Berg. “This suggests the need for alternative methods, such as ultrasound, to help screen women at increased risk for breast cancer.”

The researchers reported that 25% of the women who refused the exam cited claustrophobia, 18% cited time constraints, and 12% cited financial concerns involving insurance. Furthermore, among the 703 women who initially agreed to participate, 55 did not undergo the exam for various reasons, including withdrawal of consent, scheduling problems, and missed appointments. Ultimately, only 51.6% of the eligible women completed a screening MRI.

According to the press release announcing the findings, some groups of women at high risk for breast cancer need to begin screening at a younger age, because they often develop cancer earlier than woman at average risk. However, women below age 50 are more likely to have dense breast tissue, which can limit the effectiveness of mammography as a screening tool.

The findings were published in Radiology (2010;254[1]:79-87).

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