Assessment of Barriers to Breast MRI Screening in Individuals Identified as High-Risk for Breast Cancer
Health Services and Implementation
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Primary Categories:
- Cancer
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Secondary Categories:
- Cancer
Introduction:
The American Cancer Society (ACS) recommends that individuals who are identified as being high-risk for developing breast cancer should have breast MRI and mammogram screening every year typically starting at age 30 in comparision to the general population recommendation to have annual mammogram screening starting at age 40. One of the ways individuals may qualify as high risk is if they have a greater than 20% lifetime risk of breast cancer identified by cancer risk assessment tools such as the Tyrer-Cuzick (also referred to as IBIS) risk model. A previous study assessed trends in breast MRI utilization between 2007-2017 and identified that a maximum of 0.4% of adult women in the US received breast MRI screening annually. It is estimated, however, that 9% of women in the US are eligible for high-risk breast MRI screening, demonstrating a gap in utilization.
Methods:
An electronic medical record search query was utilized to identify the charts of women in our healthcare system who do not have a personal history of breast cancer but have been identified as high risk via Tyrer-Cuzick modeling. A random sampling of 1000 charts were manually reviewed to confirm documentation of a Tyrer-Cuzick score above 20% and to verify no prior breast cancer history and living status. A redcap survey link was sent via electronic patient portal messaging system (or a paper copy by mail if the patient portal was not active) to the 193 eligible women to assess how many have had additional breast MRI screening and what barriers exist for those who did not move forward with breast MRI screening.
Results:
A total of 57 survey responses were received. Overall 61.4% of respondents (35/57) reported that they have had at least one preventative screening breast MRI since being identified as high risk. Of those 35 respondents, 63% (22/35) reported having at least one breast MRI per year as recommended and 65.7% (23/35) reported an out-of-pocket cost for their breast MRI screening with the mean reported out of pocket cost being $2,590 (median $1,500). Of the 22 individuals who have not followed up with breast MRI screening, 72.7% (16/22) indicated they were not aware that they qualified for the additional breast MRI screening. Other responses indicated cost and distance to the nearest screening facility as barriers to screening.
Conclusion:
In this survey the largest barrier to breast MRI screening was the patient’s knowledge of their high-risk status. Breast cancer risk assessments can be performed by a variety of individuals and departments within a healthcare system; our results indicate a gap in communication of this information both to the patient and between the providers of a patient’s care team. Further review and assessment of how this information is documented and communicated is recommended to identify and address these communication gaps. It is important for patients and their providers to be aware of elevated breast cancer risk and screening resources available as early cancer detection and intervention improves outcomes for patients.
The American Cancer Society (ACS) recommends that individuals who are identified as being high-risk for developing breast cancer should have breast MRI and mammogram screening every year typically starting at age 30 in comparision to the general population recommendation to have annual mammogram screening starting at age 40. One of the ways individuals may qualify as high risk is if they have a greater than 20% lifetime risk of breast cancer identified by cancer risk assessment tools such as the Tyrer-Cuzick (also referred to as IBIS) risk model. A previous study assessed trends in breast MRI utilization between 2007-2017 and identified that a maximum of 0.4% of adult women in the US received breast MRI screening annually. It is estimated, however, that 9% of women in the US are eligible for high-risk breast MRI screening, demonstrating a gap in utilization.
Methods:
An electronic medical record search query was utilized to identify the charts of women in our healthcare system who do not have a personal history of breast cancer but have been identified as high risk via Tyrer-Cuzick modeling. A random sampling of 1000 charts were manually reviewed to confirm documentation of a Tyrer-Cuzick score above 20% and to verify no prior breast cancer history and living status. A redcap survey link was sent via electronic patient portal messaging system (or a paper copy by mail if the patient portal was not active) to the 193 eligible women to assess how many have had additional breast MRI screening and what barriers exist for those who did not move forward with breast MRI screening.
Results:
A total of 57 survey responses were received. Overall 61.4% of respondents (35/57) reported that they have had at least one preventative screening breast MRI since being identified as high risk. Of those 35 respondents, 63% (22/35) reported having at least one breast MRI per year as recommended and 65.7% (23/35) reported an out-of-pocket cost for their breast MRI screening with the mean reported out of pocket cost being $2,590 (median $1,500). Of the 22 individuals who have not followed up with breast MRI screening, 72.7% (16/22) indicated they were not aware that they qualified for the additional breast MRI screening. Other responses indicated cost and distance to the nearest screening facility as barriers to screening.
Conclusion:
In this survey the largest barrier to breast MRI screening was the patient’s knowledge of their high-risk status. Breast cancer risk assessments can be performed by a variety of individuals and departments within a healthcare system; our results indicate a gap in communication of this information both to the patient and between the providers of a patient’s care team. Further review and assessment of how this information is documented and communicated is recommended to identify and address these communication gaps. It is important for patients and their providers to be aware of elevated breast cancer risk and screening resources available as early cancer detection and intervention improves outcomes for patients.