The use of breast MRI screenings among targeted, high-risk, underserved women significantly decreased diagnostic cost and increased patient follow-up compliance rates compared to using general-risk mammography screenings, according to a study presented at the Fourth American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities, held in Washington, D.C., from Sept. 18-21.
Cost per diagnosis was $37,375 for mammography among 299 general-risk women and $21,561 for MRI among 299 high-risk women. However, the researchers, led by Anne C. Ford, MD, assistant professor in obstetrics and gynecology at Duke University Medical Center in Durham, N.C., noted that the cost of an MRI was reduced significantly by a grant specific to the study.
"What we need is to lower the cost of MRI, and maybe that will happen as we do more of them," Ford said in a statement.
The study’s abstract noted that little information was known about the relative benefits of general mammography screening vs. high-risk targeted breast MRI screening in underserved women. Mammography is relatively inexpensive, and MRI, in addition to being more expensive, can potentially increase the number of benign biopsies.
The study was conducted from 2004 to 2011; women with abnormal mammogram or abnormal breast MRI underwent additional tests, including ultrasound and/or biopsy, to confirm the presence of breast cancer. Results showed that mammographic screenings detected one breast cancer, while MRI screenings detected nine.
There were seven benign breast biopsies among the mammographic screenings, yielding an 88 percent benign biopsy rate. Among the MRI screenings, there were 31 total benign breast biopsies, but the rate of benign biopsies was actually lower at 78 percent.
"In an underserved population, using this model, it is cost effective to screen with MRI because we found more breast cancers with MRI than we did with mammography in this population," Ford said. "If you truly target high-risk women with MRIs, you can find the cancers, and you can find them early."
In addition, compliance with follow-up in mammographic screenings was 75 percent compared to 90 percent in MRI screenings. All follow-up services were provided for free.
Women were recruited by a “Breast Navigation” team from sites throughout central North Carolina, according to the study abstract. Study participants were accompanied to their screening by a member of the navigation team.
"The navigation team was key in helping the women—and these are all uninsured or under-insured women—negotiate the medical center," Ford said.