Racial Disparities in Preoperative Breast MRI Use and Surgical Margin Outcomes among Patients with Recently Diagnosed Breast Cancer

Abstract

Purpose To evaluate racial disparities in preoperative breast MRI use and surgical margin outcomes among patients with recently diagnosed breast cancer. Materials and Methods This retrospective study included patients with breast cancer who presented to a single cancer center between 2008 and 2020, underwent breast surgery, and self-identified as White or Black. Patients were divided into MRI or no-MRI cohorts based on preoperative MRI use. MRI use and positive surgical margin rates were determined for all patients and racial subgroups. Data were collected from the electronic medical record and analyzed using the χ² test for significance. Results The study included 28 384 female patients (mean age, 56 years ± 13 [SD]) with recently diagnosed breast cancer who self-identified as White (90.36%, n = 25 647) or Black (9.64%, n = 2737). Of the entire cohort, 32.78% (9305 of 28 384) underwent preoperative MRI. Black patients had a lower rate of preoperative MRI use than White patients (29.85% [817 of 2737] vs 33.10% [8488 of 25 647], respectively; P < .001). The MRI cohort had a lower positive margin rate compared with the no-MRI cohort (2.90% [133 of 4592] vs 4.78% [539 of 11 271], respectively; P = .03). In the no-MRI cohort, Black patients had a higher positive margin rate than White patients (6.17% [68 of 1103] vs 4.63% [471 of 10 168], respectively; P = .03). In the MRI cohort, there was no evidence of a difference in positive margin rates between Black and White patients (3.17% [12 of 379] vs 2.87% [121 of 4213], respectively; P = .90). Conclusion Compared with White patients, Black patients with breast cancer were less likely to undergo preoperative MRI and had a higher positive surgical margin rate. Keywords: MR Imaging, Breast Cancer, Breast MRI © RSNA, 2024 See also the commentary by Tran and Miles in this issue.

Keywords: Breast Cancer; Breast MRI; MR Imaging.

Graphical abstract

Figure 1:

Flowchart of patients included in the study.

Figure 2:

Examples of MRI in the patient cohort. (A) Preoperative contrast-enhanced axial MR image in a White patient (70-year-old female) who had negative margins at surgery, showing an enhancing mass in the right breast, upper outer quadrant, posterior depth. (B) Preoperative contrast-enhanced axial MR image in a Black patient (60-year-old female) who had negative margins at surgery, showing focal nonmass enhancement in the left breast, upper inner quadrant, posterior depth. (C) Preoperative contrast-enhanced axial MR image in a White patient (73-year-old female) who had positive margins at surgery, showing two enhancing masses in the right outer breast, anterior and posterior depths. (D) Preoperative contrast-enhanced axial MR subtraction image in a Black patient (44-year-old female) who had positive margins at surgery, showing an irregular enhancing mass with an in situ biopsy marker denoting site of carcinoma.