Impact of the 2018 ACR Supplemental Screening Recommendations on MRI Eligibility in Breast Cancer Survivors.

Abstract

The 2018 American College of Radiology (ACR) recommendations for breast cancer screening in women at higher-than-average risk include new recommendations for supplemental breast MRI for patients with a personal history of breast cancer (PHBC) who either carry a hereditary cancer gene mutation, have dense breast tissue, or were diagnosed before age 50. In comparison, prior guidelines only recommended supplemental MRI for women with PHBC who carried a hereditary cancer gene mutation. In this study, we sought to quantify the increase in number of breast cancer patients for whom supplemental breast MRI would now be recommended. Data were extracted from the electronic health record of patients presenting for screening or diagnostic mammograms at an urban academic medical center between July 20, 2020 and July 19, 2021. Data extracted including patient reported PHBC, age at time of breast cancer diagnosis, and hereditary cancer gene mutation carrier status. We report descriptive statistics evaluating the rate of eligibility for supplemental Breast MRI in a retrospective population given the new ACR guidelines. Of the 2950 patients with a self-reported PHBC who presented for breast cancer screening in a year between July 2020 and 2021, 1805 (61%) of patients met criteria for supplemental breast MRI according to the 2018 guidelines compared to only 3.6% using pre-2018 guidelines. Measuring the impact of the 2018 ACR supplemental MRI recommendations using real-world data at a single urban academic medical center demonstrated a 15-fold increase in potential eligibility for supplemental breast MRI in patients with a PHBC.