Researchers affiliated with the American College of Radiology Imaging Network (ACRIN) 6666 US Screening Protocol have reported that only 58% of women at high risk of breast cancer agreed to be screened by magnetic resonance imaging (MRI). The details of this study appeared in the January 2010 issue of Radiology.[1]

Breast cancer is the second leading cause of cancer death in women in the United States, with approximately 180,000 cases diagnosed each year. Women with a family history of breast cancer are at an increased lifetime risk of developing the disease, as are women who carry a BRCA mutation. These women are encouraged to undergo more vigilant screening to allow for earlier detection and higher cure rates.

The American Cancer Society has recommended annual breast MRI for the following high-risk groups:[2]

• Women with a BRCA1 or BRCA2 mutation
• Women who have a first-degree relative with a BRCA mutation (even if they have not yet been tested themselves)
• Women who have a 20-25% or greater risk of breast cancer based on risk assessment tools (which utilize family history)

The current study evaluated the acceptance of breast MRI screening in women at high risk of breast cancer. This study enrolled women at elevated risk of breast cancer. Information about acceptance of breast MRI was available for 1,215 of the women.

• 42% of the women declined MRI.
• Women with a 25% or greater lifetime risk of developing breast cancer were more likely to participate.
• The most common reason for MRI refusal was claustrophobia (25.4%).
• Time constraints were a cause of refusal in 18.2%.
• Financial concerns were responsible for 9.2% of refusals, even though the MRI was free. These participants were worried about the costs of any additional testing that may be necessary.
• In 9.2% a physician did not believe the test was necessary and would not provide a referral.
• 7.8% of women were “not interested.”
• 7.6% were described as “medically intolerant to MR imaging.”
• 5.7% refused because of the need for intravenous injection.
• 5.3% refused because of concern about the need for a biopsy or other procedure.
• 4.1% had scheduling constraints.
• 2.2% refused because of travel requirements.
• 1.4% had gadolinium-related risks or allergies.
• 1.2% of refusals were for unknown reasons.

Comments: Currently, MRI is the best screening test available to detect early breast cancer. Widespread use has been hindered predominantly by expense; otherwise, it would replace mammography. These results indicate that the compliance rate for free MRI screening in high-risk women is only 58%. These are remarkable findings and suggest that newer strategies are needed to convince women of the importance of early detection of breast cancer. The high rate of refusal due to claustrophobia was unexpected, and 25% seems to be higher than MRI performed for other diseases.

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