Patients refusing breast MRI not as common as it seems, experts say

Recent news coverage makes it seem as if women at high risk for breast cancer are refusing breast MRI screening left and right. That’s simply not the case, according to several experts.

The presumption hinges on a study published in Radiology in which 42.1% of women refused to be screened for breast cancer using MR. About a quarter of them cited claustrophobia as a concern and another 18.2% said time constraints were an issue.

“I do not think the study’s finding is representative of most clinical practices evaluating patients with a diagnosis of breast cancer, or high-risk screening,” said Dr. Kathy Schilling from Boca Radiology in Boca Raton, FL.

The women who are recommended for MR imaging are highly motivated because they are either at high risk for breast cancer or recently diagnosed with the disease. They want to undergo screening, said Dr. Constance Lehman, vice chair of radiology at the University of Washington in Seattle, and director of breast imaging at Seattle Cancer Care Alliance.

What may have happened in this study, which was a part of the American College of Radiology Imaging Network Trial 6666, is the 1215 women included were tired. Tired of being researched. Tired of undergoing screening modalities. After all, the women had already completed three rounds of annual screening with mammography and ultrasound before being approached for MR screening.

Lead author of the study Dr. Wendie Berg, a breast imaging specialist at Johns Hopkins Health Care and Surgery Center at Green Spring Station in Lutherville, MD, admits as much in her discussion section.

“Although researchers were encouraged to provide summary data from trials that included both MR imaging and ultrasound examinations.…many participants in the main ACRIN 6666 protocol may have felt secure with their mammography and ultrasound results alone, or believed they were ‘doing enough,’” she said.

The moral of the story? Breast imagers don’t need to worry just yet; high-risk patients are still coming in for MR screening.

The ACRIN 6666 trial was supported by grants from the Avon Foundation and the National Cancer Institute.