Many women willing to pay more for screening MRI, particularly those with dense breasts

Most women are not satisfied with only undergoing mammography to screen for breast cancer and many are willing to pay more out of pocket for other imaging exams, according to survey results published Friday.

In fact, out of nearly 1,000 patients scheduled for a mammogram, only 34.7% were content with their breast screening plan. And more than half were willing to shell out at least $250-$500 for an MRI exam, particularly those with dense breasts, researchers reported April 9 in Academic Radiology.

Breast MRI and contrast-enhanced mammography (CEM) are primarily used in high-risk women due to their enhanced sensitivity, yet adverse contrast reactions, false positives and unnecessary biopsies are all known downsides to using these techniques.

But it appears women, at least at this single institution, aren’t concerned with these risks.

“Prior to our study, little was known whether asymptomatic patients in the general screening population would accept the associated downsides and risks related to contrast-enhanced imaging despite improved cancer detection compared to conventional mammography,” Daniel Son, MD, and co-authors with the Division of Breast Imaging at Beth Israel Deaconess Medical Center and Harvard Medical School explained.

To reach their conclusions, Son et al. surveyed all patients undergoing screening mammography at their institution between December 27, 2019, and March 6, 2020. In total, 1,011 of the 1,349 individuals completed the questionnaire.

More than half reported having dense breasts and of those, 49.6% had been called back, 29% had a benign biopsy and 13.7% a prior CEM/MRI.

Below are additional findings.

  • A majority of women were neutral or not concerned with the risks and downsides of contrast-enhanced imaging, including radiation exposure (70.3%), contrast reaction (75.4%), IV line placement (82.2%), claustrophobia (67.4%), and false positives (70.7%).
  • Patients were even less concerned with an allergic reaction, IV, and claustrophobia if they had undergone a prior breast MRI or CEM exam.
  • Those who had a previous benign biopsy or MRI/CEM exam weren’t as worried about false positives as much as others.  
  • Patients with dense breasts were less satisfied with mammography screening and more willing to pay out of pocket for MRI. Furthermore, 10.3% said they would pay $500-$1,000.

Mammography is still considered the gold standard for screening, the authors noted. Breast MRI is limited by high costs and low availability, while CEM is a newer technique that requires radiation, they added.

Son and co-authors said most of their findings align with prior research and indicated there may be a desire for supplemental imaging in some women undergoing breast cancer screening.

“In conclusion, our study suggests that women may accept contrast-enhanced imaging with CEM or MRI as a screening exam despite its risks and costs, especially if they have dense breasts and have had prior experience with CEM or MRI,” the authors concluded.

Read the entire study here.

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