Abstract
Background: Our current recommendations for mammographic and MRI screening are based on studies in European, European-Canadian and European-American women. To our knowledge, there has been no large-scale analysis of the effectiveness of mammographic screening in African-American and Latino women. We have little information on the relative benefits of general mammography screening versus high-risk targeted breast Magnetic Resonance Imaging (MRI) screening in underserved women. Mammography has the advantage of being relatively inexpensive and well accepted. In contrast, MRI is expensive and has the potential to increase the number of benign biopsy.
Methods: We compared the ability of mammography screening in a general risk underserved population (standard-of-care) with targeted breast MRI screening in high-risk underserved women to a) detect breast cancer, b) cost of screening/breast diagnosis, c) number of benign biopsies, and d) compliance. From 6/15/2004 to 5/7/2011, 1) 299 general risk women underserved women were underwent digital mammographic screening and 2) 299 high-risk women underwent combined mammogram and breast MRI screening. Women were recruited by our Breast Navigation team from sites throughout central North Carolina and underwent screening accompanied by a member of our Navigation team. Women found to have an abnormal mammogram were evaluated by ultrasound, ultrasound guided biopsy, and/or stereotactic biopsy. Women with an abnormal breast MRI were evaluated with ultrasound, ultrasound guided biopsy, and/or MRI guided biopsy. All follow-up services were provided for free.
Results: The average age of women was 50 years for women undergoing mammographic screening and 47 years for women undergoing MRI. The racial composition of general-risk women undergoing mammographic screening was 40% African American, 25% Caucasian, 25% Hispanic, and 1% other vs. 33% African American, 62% Caucasian, 3% Hispanic, and 2% other for high-risk women undergoing breast MRI. Mammographic screening detected 1 breast cancer vs. 9 for MRI. The cost per diagnosis was $37,375.00 vs. $21,561.22.
The number of benign breast biopsies/total biopsies was 7/8 (88%) for mammographic screening vs. 31/40 (78%) for MRI. Compliance with follow-up studies was 75% for mammographic screening vs. 90% for MRI.
Conclusions: Breast MRI screening in high-risk underserved women is highly feasible and with Navigation, there is a high rate of compliance with follow up studies. The cost per breast cancer diagnosis is significantly lower for targeted breast MRI screening of high-risk women than for mammographic screening of general risk women.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B101.
