Women not following through with recommended breast screening MRI

A study of 64,659 women, recently published in the journal Academic Radiology, found that while 1,246 of these women were at high enough breast cancer risk to recommend additional screening with MRI, only 173 of these women returned to the clinic within a year for the additional screening.

“It’s hard to tell where, exactly, is the disconnect,” says Deborah Glueck, PhD, investigator at the University of Colorado Cancer Center and associate professor of biostatistics and informatics at the Colorado School of Public Health, the paper’s senior author.

But no matter the disconnect, the result is clear: women who should be getting breast screening MRI are not.

Along with her PhD student, John Brinton, Glueck got interested in the data of MRI breast screening soon after the 2007 recommendation by the American Cancer Society that women at elevated lifetime risk for developing breast cancer be screened with MRI in addition to yearly mammograms. In fact, despite most major health insurances offering coverage, few clinics put the recommendation into practice.

An exception is Invision Sally Jobe Breast Centers, in the researchers’ Denver, Colo. backyard.

“The Invision Sally Jobe Breast Centers and our collaborators, Dr. Lora Barke, Mary Freivogel and Stacy Jackson have been invaluable partners in our research,” Glueck says.

At Invision Sally Jobe, clinicians were using the National Cancer Institute’s Gail Model to identify a patient’s lifetime risk of developing breast cancer. For women with greater than 20 percent lifetime risk, the clinic included in the mammography results that were sent to women’s primary care physicians a note explaining the elevated risk and suggesting that the physician refer high-risk women for the recommended MRI.

Women and men diagnosed with stage 0 breast cancer have a 100 percent chance of survival after treatment. Those diagnosed with stage II have a 98 percent chance; virtually everyone survives this stage for at least five years. After stage II, survival rates drop quickly. Those diagnosed with stage IIA breast cancer have a 92 percent survival rate, while those with stage IIB face an 81 percent chance. Stage IIIA has a 67 percent survival rate, and with stage IIIB the rate drops to 54 percent. Those with stage IV breast cancer, the most advanced stage, face a mere 20 percent chance that they will live five years after the diagnosis. When diagnosed with stage IV breast cancer, the patient and treating physician have the difficult task of developing an aggressive treatment plan while maintaining a reasonable quality of life for the patient. Treatment plans at this stage are very personal and require much time and consultation between the patient, physicians, and family members. It is important to note that, while stage IV survival rates may be less than optimal, many individuals can and do survive stage IV breast cancer for a good number of years after their diagnosis, adding several quality years to their life.