Abstract P2-02-02: Uptake and Predictors of Screening Breast MRI in High Risk Women

Abstract

Abstract BACKGROUND: Screening breast MRI is recommended in: BRCA carriers, their first degree relatives who have yet to test, and women with lifetime breast cancer risks of over 20-25%. It is unclear, however, whether women who receive screening breast MRI meet any of these criteria. As screening breast MRI becomes more available and accepted, it is also important to describe its uptake and identify its predictors. OBJECTIVE: To determine the uptake over time of screening breast MRI, as well as predictors of receiving screening breast MRI, in a cohort of women at high risk of hereditary breast cancer. METHODS: We surveyed all cancer-free women who enrolled in the UCSF Cancer Risk Program to determine their uptake of screening breast MRI, including their frequency of screening and the results of this screening. We also queried these women regarding their their risk perception, cancer worry, knowledge of high-risk screening recommendations, and their satisfaction with clinical care. We linked survey data to clinical and demographic data. Descriptive and comparative statistics, as well as multivariate logistic regression, were used to analyze this data. RESULTS: The survey response rate was 80% (n = 433) and the median follow up time was 2.7 years (range 0.5 — 12 years). The uptake of screening breast MRI doubled between 2005 and 2006, and doubled again between 2006 and 2008, with an overall uptake of 25% for ever receiving a screening breast MRI. Of the 92 BRCA carriers in this cohort, 74% reported every receiving a screening breast MRI compared to 18% of non-BRCA carriers (P<0.01). The mean age of first screening breast MRI in this cohort was 40 (range 25-61) compared to the mean age overall of 47 (p = 0.03). Ten percent of women who received screening breast MRI reported that their study required a “call-back” and/or further imaging. Using the BRCAPRO risk prediction model to calculate lifetime risk, without knowing BRCA resutls, 28% of this population would meet the 20% lifetime risk threshold. When BRCA results are incorporated into this risk model, 20% of this population would meet the 20% lifetime risk threshold. Variables associated with obtaining a screening breasat MRI are in the table 1 below. Table 1. Variables independently associated with screening breast MRI use in 433 high risk women withou t breast cancer CONCLUSIONS: Screening breast MRI is growing substantially. Its use to date demonstrates adherence with high-risk recommendations and guidelines. BRCA positive status is the strongest predictor of its uptake, and most BRCA carriers report receiving at least one screening breast MRI. Early trends indicate that variables not associated with risk, such as site of care (public versus university hospital) and race, may play a role in the uptake of screening breast MRI as its use becomes more widespread. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-02.