We’ve discussed the potential overuse of mammograms before. We’ve discussed how diagnosis has increased without comparable reductions in mortality. Now we get to talk about
mammograms MRIs and breast cancer:
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.
No one is disputing that MRI is a sensitive test for breast cancer. What many dispute is its cost-effectiveness. That hasn’t stopped its use from increasing by more than 2000% percent from 2000-2011.
Here’s the bottom line: most of the women who were screened for breast cancer by MRI didn’t have documentation warranting it. Many more women who did have a genetic mutation who might have benefitted from MRI screening didn’t get it.
Best in the world?
UPDATE: Edited cause I was tired last night.