Early uptake of breast magnetic resonance imaging in a community-based medical practice, 2000-2004

Abstract

Background: Clinical applications of magnetic resonance imaging (MRI) of the breast have expanded across the breast cancer detection and control spectrum over the past decade. Use appears to be growing, although evidence for or against its use is still accumulating.

Methods: Using electronic health plan and medical record data, we documented early trends in breast MRI use from 2000 through 2004 in a large community practice setting with approximately 82,000 eligible female patients. During the study period, 225 women received at least one breast MRI; of those, 64 had subsequent MRI (for a total of 333 MRIs).

Results: Utilization grew from 6 MRIs in 2000 to 112 in 2004, with increasing use for screening, diagnosis, disease staging/treatment, and surveillance purposes. Diagnostic use accounted for nearly half of the breast MRIs (164 of 333). In this community-based practice, there was rapid uptake of this new technology despite paucity of evidence about its uses.

Conclusions: As new evidence is generated, use of this technology will need to be monitored to minimize the risk of overuse and unintended downstream consequences.

FIG. 1.

Number of initial and subsequent breast magnetic resonance imaging (MRI) by clinical indication and calendar year, 2000–2004. Shown are frequencies of clinical indications for 313 of the 333 breast MRIs where indication could be determined. Breast MRIs indications were defined as (1) screening, if performed on a asymptomatic woman without previously noted abnormalities and without prior breast cancer, (2) diagnostic, if performed because of abnormalities noted by the woman, clinician, or imaging performed in the prior 6 months, (3) staging/treatment, if performed within 6 months of a new breast cancer diagnosis or before completion of initial breast cancer treatment, and (4) surveillance for recurrence, if performed on a woman with prior breast cancer diagnosis and no new symptoms or findings. In our community setting, breast MRI use has increased over time for all indications.