20 Sep Breast MRI Screening Can Cut Costs, Boost Follow-up Compliance

AuntMinnie | Breast cancer MRI screening among high-risk, underserved women can significantly decrease diagnostic costs and increase patient compliance with follow-up appointments compared with general-risk mammography screenings, according to a study presented September 20 at the American Association for Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Washington, DC.

The cost per diagnosis in the study was $37,375 for mammography, compared with $21,561 for MRI. The savings may be somewhat skewed, however, because the cost of an MRI scan was reduced by a grant specific to the study, from an average of $3,500 per scan to $649.

Despite the financial help, lead researcher Dr. Anne C. Ford, an assistant professor in obstetrics and gynecology at Duke University Medical Center in Durham, NC, said MRI “in an underserved population, as long as the patients are high risk, is a very feasible option.”

The study compared breast cancer mammography screening in 299 general-risk, underserved women to MRI screening among 299 high-risk, underserved women between 2004 to 2011. The women who received mammograms were an average age of 50 years old, while women who received an MRI were an average age of 47 years.

High cancer risk

High-risk women are those with a greater than 20% lifetime risk for breast cancer due primarily to family history and a close relative with breast cancer, especially at an early age. High-risk women are candidates for MRI screening on an annual basis.

The general-risk women received only mammograms, while the high-risk women received both a mammogram and an MRI scan. Women with abnormal mammograms or abnormal breast MRI exams also received ultrasound, ultrasound-guided biopsy, and/or stereotactic biopsy for mammogram cases, and/or MRI-guided biopsy for MRI cases.

Results showed that mammography detected one breast cancer among eight women in the general-risk category who were called back due to abnormal results. MRI screenings detected seven breast cancers among the 38 high-risk women were called back due to abnormal results.

The number of benign breast biopsies/total biopsies was seven of eight cases (88%) for mammographic screening, compared with 31 of 40 cases (78%) for MRI.

The study also found that compliance with a follow-up appointment among women who received mammographic screenings was 75%, compared with 90% for those screened by MRI.

Ford credited the compliance rate to the utilization of a breast navigation team, which recruited study participants from the general population at health and screening fairs in central North Carolina. Navigation teams include nurses and other healthcare professionals who keep in touch with patients to help guide them through the screening process and with follow-up appointments, including back-and-forth transportation.

Preliminary results

“This is a preliminary study, because our numbers are small,” Ford told AuntMinnie.com. “It is not ready to be published yet, but [the study] brings up some interesting findings. We were evaluating the feasibility of screening underserved women at high-risk [of breast cancer] with MRI. Is it a feasible thing to even think about doing?”

MRI is a much more expensive test than mammography. The issue is cost versus benefit and whether it is worth screening with the more expensive test.

“It is worth it, if you catch the cancer much sooner and you can save costs down the road on chemotherapy and surgery, but that is a much more complicated question,” Ford said. “From a healthcare economics standpoint, in the future we plan to get a healthcare economist to help us model the cost of screening.”

Without the financial help of the grant, Ford estimated the cost of MRI scan at $2,200 to $2,300, but there are managed care plans with negotiated rates for MRI. “In one health system,” she added, “the MRI may be reimbursed at $1,000, but it is very hard to find an average cost. You can find a charge, but it is very hard to find the payment.”

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