In a new study published in the January issue of Radiology, 42 percent of women eligible for breast cancer screening with MRI declined to undergo the procedure.
"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 Wendie A. Berg, M.D., Ph.D., breast imaging specialist at American Radiology Services, Johns Hopkins - Green Spring Station in Lutherville, Md. "This suggests the need for alternative methods, such as ultrasound, to help screen women at increased risk for breast cancer."
Some groups of women who are at high risk for breast cancer need to begin screening at a younger age, because they often develop cancer earlier than women 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.
Multicenter trials have shown that MRI enables radiologists to accurately identify tumors missed by mammography and ultrasound. The American Cancer Society recommends that some groups of women with a high risk of developing breast cancer should be screened with MRI in addition to their yearly mammogram beginning at age 30.
Two factors known to reduce patient acceptance of breast MRI include claustrophobia and the requirement of an intravenous contrast agent. Open MRI causes less anxiety and claustrophobia than closed MRI, but its lower field strength does not allow optimal breast imaging.
As part of the American College of Radiology Imaging Network (ACRIN) 6666 trial, Dr. Berg and colleagues set out to gauge patient acceptance of MRI as a breast screening tool. For the MRI study, 1,215 eligible women at intermediate or high risk for breast cancer enrolled in the ACRIN 6666 trial were offered a contrast-enhanced screening MRI exam. Of those women, only 703 (57.9 percent) agreed to the exam and only 51.6 percent completed the exam per protocol.