For women with recently diagnosed breast cancer, new research reveals disparities between Black women and White women with respect to the use of preoperative magnetic resonance imaging (MRI) and positive surgical margin rates in those patients who don’t have preoperative MRI.
For the retrospective study, recently published in Radiology: Imaging Cancer, researchers reviewed data from 28,384 women (mean age of 56) who had surgery for recently diagnosed breast cancer. The cohort was comprised of 25,647 White women and 2,737 Black women, according to the study. The study authors noted that 9,305 patients had preoperative MRI.
The researchers found that 29.85 percent of Black women had preoperative MRI in comparison to 33.10 percent of White women. In the cohort of patients with no preoperative MRI, the positive surgical margin rate for Black women was 6.17 percent in contrast to 4.63 percent for White women, according to the study authors.
“This study builds upon the growing literature demonstrating racial disparities in breast cancer care and treatment. Black female individuals are more likely to die of breast cancer at any age, receive a breast cancer diagnosis at a younger age, and have more aggressive disease yet, they are less likely to obtain adequate treatment,” wrote lead study author Amber Simmons, M.D., who is affiliated with the Department of Radiology at the Hospital of the University of Pennsylvania in Philadelphia, and colleagues.
While noting that orders for breast MRI exams are “highly dependent” upon the preferences of breast surgeons, the researchers emphasized that a variety of factors may play a role in disparities with the utilization of preoperative breast MRI.
“Other potential causes for this disparity include barriers to undergoing a breast MRI examination, such as geographic access to a breast MRI facility, health insurance, financial means to support out-of-pocket costs, and breast MRI offered at hours that accommodate work schedules,” pointed out Simmons and colleagues.
Three Key Takeaways
1. Lower preoperative MRI use in Black women. Black women with recently diagnosed breast cancer were less likely to receive preoperative MRI compared to White women (29.85 percent vs. 33.10 percent).
2. Higher positive surgical margin rates. Among patients who did not undergo preoperative MRI, Black women had a higher rate of positive surgical margins (6.17 percent) compared to White women (4.63 percent), suggesting potential disparities in surgical outcomes.
3. Potential impact of systemic barriers. The study authors noted a variety of potential barriers contributing to the disparity, including limited geographic access to MRI facilities, insurance issues, and financial challenges that may hamper one's ability to receive optimal breast cancer care.
While pointing out that research has demonstrated the benefits of preoperative breast MRI for an array of indications including women with dense breasts, invasive lobular carcinoma, mammographically occult breast cancer or high-grade ductal carcinoma in situ, the researchers found that only a third of the overall cohort had preoperative breast MRI.
“ … Inconsistencies in preoperative MRI use between racial subgroups may be associated with downstream clinical consequences that exacerbate racial health disparities. This study thus provides further justification to investigate and mitigate disparities in breast MRI use and improve poor surgical outcomes among racial and ethnic minority patients, potentially through addressing barriers patients may face in obtaining a breast MRI examination or exploring subjective practice patterns in MRI triaging,” emphasized Simmons and colleagues.
(Editor’s note: For related content, see “Study: Use of Preoperative MRI 46 Percent Less Likely for Black Women with Breast Cancer,” “Should Race and Ethnicity Factor into Starting Ages for Mammography Screening?” and “Study of Mammography AI Software Notes 50 Percent Higher Likelihood of False-Positive Results for Black Women.”)
In regard to study limitations, the authors acknowledged the cohort was drawn from a single tertiary facility and was largely comprised of White women (over 90 percent). The researchers also noted that possible confounding factors such as family history of cancer and comorbid conditions were not evaluated in the study.
