title: Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status.
abstract: BACKGROUND
  Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities.
  
  
  METHODS
  Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a <20% lifetime breast cancer risk and RR in the absence of MRI use by women with a ≥20% lifetime risk.
  
  
  RESULTS
  Among women with a <20% lifetime risk of breast cancer, non-Hispanic white women were found to be 62% more likely than nonwhite women to undergo an MRI (95% confidence interval, 1.32-1.98). Of these women, those with an educational level of some college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63).
  
  
  CONCLUSIONS
  Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines.
authors.affiliation: Division of General Internal Medicine and Primary Care, Department of Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Department of Internal Medicine and Cancer Research Center and School of Medicine, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hill
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Wellman
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington.|Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.affiliation: Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Stout
authors.affiliation: Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.affiliation: Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Alford-Teaster
authors.affiliation: Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Onega
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008327:Mammography; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D012306:Risk; D012923:Social Class; D014481:United States; D044465:White People
keywords: breast cancer screening; guidelines; health disparities; primary care