Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1798–1805 | Cite as

Factors Associated with Breast MRI Use: A Population-Based Analysis

  • Brigid K. Killelea
  • Donald R. Lannin
  • Laura J. Horvath
  • Nina R. Horowitz
  • Anees B. Chagpar
Healthcare Policy and Outcomes



Although controversial, the use of breast magnetic resonance imaging (MRI) is widespread. We sought to determine factors that influenced its use in a population-based sample.


The National Health Interview Survey is conducted annually by the Centers for Disease Control and is designed to be representative of the American population. Data from 2010 were queried for the use of breast MRI and associated sociodemographic and risk characteristics.


Of the 11,222 women aged ≥30 years who were surveyed, 4.7 % reported ever having a breast MRI. Nearly a quarter were done as part of a “routine exam” and <5 % were done for “family history” or for “high risk.” Factors correlating with MRI use on univariate analysis included age, race, personal and/or family history of breast cancer, history of benign breast biopsy, perceived risk, and insurance. On multivariate analysis, African-American race (p = 0.001), personal history (p < 0.001), history of benign biopsy (p < 0.001), and high perceived risk (p < 0.001) were significantly associated with increased MRI use. In a cohort without a personal history of breast cancer, race, history of benign biopsy, and perceived risk were independent correlates of breast MRI, whereas family history, age, and insurance were no longer significant.


Personal history is the strongest factor associated with breast MRI use. However, whereas race, history of benign biopsy, and perceived risk were independently associated with MRI use, family history was not. These findings call into question whether current practice patterns follow evidence-based guidelines.


Breast Cancer Magnetic Resonance Imaging Personal History National Health Interview Survey Breast Magnetic Resonance Imaging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





  1. 1.
    Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75-89.PubMedCrossRefGoogle Scholar
  2. 2.
    National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines 2012. Accessed 25 Feb 2012.
  3. 3.
    Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209(2):180-7.PubMedCrossRefGoogle Scholar
  4. 4.
    Hwang N, Schiller DE, Crystal P, et al. Magnetic resonance imaging in the planning of initial lumpectomy for invasive breast carcinoma: Its effect on ipsilateral breast tumor recurrence after breast conservation therapy. Ann Surg Oncol. 2009;16(11):3000-9.PubMedCrossRefGoogle Scholar
  5. 5.
    Katipamula R, Degnim AC, Hoskin T, et al. Trends in Mastectomy Rates at the Mayo Clinic Rochester: Effect of surgical year and preoperative magnetic resonance imaging J Clin Oncol. 2009;27(25):4082-8.PubMedCrossRefGoogle Scholar
  6. 6.
    Friedlander LC, Roth SO, Gavenonis SC. Results of MR imaging screening for breast cancer in high-risk patients with lobular carcinoma in situ. Radiology. 2011;2561(2):421-7.CrossRefGoogle Scholar
  7. 7.
    Morrow M. Magnetic resonance imaging for screening, diagnosis, and eligibility for breast-conserving surgery: promises and pitfalls. Surg Oncol Clin N Am. 2010;19(3):475-92.PubMedCrossRefGoogle Scholar
  8. 8.
    Kuhl CK, Scrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370:458-92.Google Scholar
  9. 9.
    Thornton H. Should we undertake an MRI breast screening trial? Lancet. 2007;370:1903.PubMedCrossRefGoogle Scholar
  10. 10.
    Heywang SH, Wolf A, Pruss E, Hilbertz T Eiermann W, Permanetter W. MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 1989;171(1):95-103.PubMedGoogle Scholar
  11. 11.
    D’Orsi CJ, Newell MS. On the frontline of screening for breast cancer. Sem Oncol. 2011;38(1):119-27.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaiser WA, Zeitler E. MR imaging of the breast: Fast imaging sequences with and without Gd-DTPA-preliminary observations. Radiology. 1989;179:681-6.Google Scholar
  13. 13.
    Graubard BI, Freedman AN, Gail MH. Five-year and lifetime risk of breast cancer among U.S. Subpopulations: implications for magnetic resonance imaging screening. Cancer Epidemiol Biomarkers Prev. 2010;19:2428-9.CrossRefGoogle Scholar
  14. 14. US breast cancer statistics. Accessed 10 March 2012.
  15. 15.
    Gorechlad JW, McCabe EB, Higgins JH, Likosky DS, Lewis PJ, Rosenkranz KM, Barth RJ. Screening for recurrences in patients treated with breast-conserving surgery: is there a role for breast MRI? Ann Surg Oncol. 2008;15(6):1703-9.PubMedCrossRefGoogle Scholar
  16. 16.
    Kriege, M, Brekelmans, CT, Boetes, C, Besnard, PE, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004:351:427-37.PubMedCrossRefGoogle Scholar
  17. 17.
    Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004;292:1317-25.CrossRefGoogle Scholar
  18. 18.
    Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 2005;23:8469-76.PubMedCrossRefGoogle Scholar
  19. 19.
    Ickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: Racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006;24:1357.CrossRefGoogle Scholar
  20. 20.
    Sommer, CA, Stitzenberg KB, Tolleson-Rinehart S, Carpenter WR, Carey TS. Breast MRI utilization in older patients with newly diagnosed breast cancer. J Surg Res. 2011;170:77–83.PubMedCrossRefGoogle Scholar
  21. 21.
    El-Bastawissi AY, White E, Mandelson MT, Taplin S. Variation in mammographic breast density by race. Ann Epidemiol. 2001;11(4):257-63.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Brigid K. Killelea
    • 1
    • 3
  • Donald R. Lannin
    • 1
  • Laura J. Horvath
    • 2
  • Nina R. Horowitz
    • 1
  • Anees B. Chagpar
    • 1
  1. 1.Department of SurgeryYale University School of MedicineNew HavenUSA
  2. 2.Diagnostic RadiologyYale University School of MedicineNew HavenUSA
  3. 3.The Breast Center, Smilow Cancer Hospital at Yale-New HavenNew HavenUSA

Personalised recommendations