Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan;174(1):114-21.
doi: 10.1001/jamainternmed.2013.11958.

Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011

Natasha K Stout  1 , Larissa Nekhlyudov  2 , Lingling Li  1 , Elisabeth S Malin  3 , Dennis Ross-Degnan  1 , Diana S M Buist  4 , Marjorie A Rosenberg  5 , Marina Alfisher  6 , Suzanne W Fletcher  1
Affiliations

Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011

Natasha K Stout et al. JAMA Intern Med. 2014 Jan.

Abstract

Importance: Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. How breast MRI is actually used in community settings is unknown.

Objective: To describe breast MRI trends and indications in a community setting.

Design, setting, and participants: Retrospective cohort study at a not-for-profit health plan and multispecialty group medical practice in New England of 10,518 women aged 20 years and older enrolled in the health plan for at least 1 year who had at least 1 breast MRI between January 1, 2000, and December 31, 2011.

Main outcomes and measures: Breast MRI counts were obtained from claims data. Clinical indication (screening, diagnostic evaluation, staging or treatment, or surveillance) was determined using a prediction model developed from electronic medical records on a subset of participants. Breast cancer risk status was assessed using claims data and, for the subset, also through electronic medical record review. RESULTS; Breast MRI use increased more than 20-fold from 6.5 per 10,000 women in 2000 to 130.7 per 10,000 in 2009. Use then declined and stabilized to 104.8 per 10,000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening.

Conclusions and relevance: Breast MRI use increased steeply over 10 years and then stabilized, especially for screening and surveillance among women with family or personal history of breast cancer; most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting ACS criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Panel A: Age-specific rates of breast MRI use from 2000 through 2011. Each bar within an age-group represents a calendar year. Panel B: Indication-specific rates of breast MRI use from 2000-2011 for four primary indications: screening, diagnostic, staging/treatment, surveillance.
Figure 1
Figure 1
Panel A: Age-specific rates of breast MRI use from 2000 through 2011. Each bar within an age-group represents a calendar year. Panel B: Indication-specific rates of breast MRI use from 2000-2011 for four primary indications: screening, diagnostic, staging/treatment, surveillance.
See this image and copyright information in PMC

Comment in

References

    1. Harms SE, Flamig DP. Breast MRI. Clin Imaging. 2001;25(4):227–246. - PubMed
    1. DeMartini W, Lehman C, Partridge S. Breast MRI for Cancer Detection and Characterization: A Review of Evidence-Based Clinical Applications. Acad Radiol. 2008;15(4):408–416. - PubMed
    1. Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic Review: Using Magnetic Resonance Imaging to Screen Women at High Risk for Breast Cancer. Ann Int Med. 2008;148(9):671–679. 2008. - PubMed
    1. Lord SL, Lei W, Craft P, et al. A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 2007;43:1905–1917. - PubMed

    1. Bruening W, Uhl S, Fontanarosa J, Reston J, Treadwell J, Schoelles K. Comparative Effectiveness Review No. 47. Agency for Healthcare Research and Quality; Rockville, MD: Feb, 2012. Noninvasive diagnostic tests for breast abnormalities: Update of a 2006 review. www.effectivehealthcare.ahrq.gov/reports/final.cfm (Prepared by the ECRI Institute Evidence-based Practice Center under Contract No. 290-02-0019.) AHRQ Publication No. 12-EHC014-EF.

Publication types

MeSH terms