An epidemiologist identifies who is appropriately undergoing this imaging for breast cancer and who is 不.

By 凯伦Wernli, 博士学位, an epidemiologist who is an associate investigator at 凯撒永久医疗机构华盛顿 Health 世界杯下注网站 Institute

Coinciding with the start of Breast 癌症 Awareness Month, I published a 纸 癌症 关于你.S. 女性使用核磁共振成像来筛查乳腺癌. I’ve been studying how we use breast MRI in the United States for a decade, as this technology has emerged as clinical screening tool from the diagnostic imaging. As the use of breast MRI has increased over the past 20 years, 重要的是要知道谁在接收它, 为什么他们会收到, and whether or 不 health services are aligned with national clinical guidelines.

Our results from analyzing data over a 10-year span (2006-16) indicate that this technology is now being used more commonly among women who are recommended to receive it, 尽管仍有改进的余地. 的 癌症 article, which I wrote with colleagues from leading medical schools, documents this shift and spotlights where clinical care teams can be doing better in referrals for breast MRI. It is one of the first studies to evaluate breast MRI trends from a broad national sample by subgroups of those recommended (已知BRCA的女性) and non-recommended groups (women with family history alone and women with prior breast cancer). 我们的论文提出了3个主要发现.

第一个, the overall rate of use of breast MRI is low in a national population, which makes sense because most women will 不 routinely need this imaging test. 适当地, 已知BRCA的女性, a genetic condition that significantly increases cancer risk, 乳房核磁共振成像的总体比例最高, and the rates have increased on average by 21% per year. Women with known BRCA are recommended to screen for breast cancer with both mammography and breast MRI, 根据国家临床指南.

第二个, the overall rate of use of breast MRI was highest among 已知BRCA的女性 age 50-64, 但在30多岁和40多岁的女性中，这一比例较低. This represents a clear opportunity to improve surveillance. 的se younger women could benefit from use of breast MRI. Breast cancer incidence in 已知BRCA的女性 rapidly increases during their 30s and 40s before rates stabilize when women are in their 50s. Younger 已知BRCA的女性 also face the conflict of  starting or adding to their families versus clinical recommendations to undergo prophylactic surgery to mitigate their cancer risk. Screening younger women with mammography and breast MRI could delay these decisions.

最后, despite low overall rates and improving breast MRI rates in women who meet the recommended guidelines, still nearly 4 out of 5 breast MRIs are performed in women who are 不 currently recommended—women with a family history of breast cancer alone and women with a personal history of breast cancer. 的se findings confirmed previous findings in the 乳腺癌监测协会 that a large proportion of women with a family history alone are more likely to get breast MRI, 即使他们个人患癌症的风险很低. 此外, 虽然在世界杯下注网站期间没有观察到, the American College of Radiology has recommended breast MRI for women with prior breast cancer if they have dense breasts or were diagnosed before age 50. My own 世界杯下注网站 has shown that breast MRI might 不 have improved accuracy over mammography in this population.

综上所述, the findings suggest that there is tremendous potential improved alignment of the use of breast MRI in guideline-recommended populations. 的re is a well-identified opportunity to support women who are 不 being offered breast MRI but would benefit, particularly by targeting younger 已知BRCA的女性. One way to achieve that goal is electronic health record support in the identification of women eligible to prompt conversations with their clinicians.

Breast 癌症 Awareness Month is a time to honor how much we have learned about breast cancer and the progress we have made. It also gives us the chance to set new goals and take steps to move toward them. I am pleased that our paper can contribute to these efforts.