Findings from a new study of patients with breast cancer suggest that Black women are significantly less likely to receive preoperative magnetic resonance imaging (MRI) than White women.
For the retrospective study, recently published in JCO Oncology Practice, researchers reviewed data from 1,410 women (mean age of 60.4) with stage 0-III breast cancer to compare the use of preoperative MRI and subsequent surgical management in non-Hispanic White and Black women. Seventy-three percent of the cohort was comprised of White women and 27 percent were Black women, according to the study.
The researchers found that Black women were 46 percent less likely than White women to receive preoperative MRI exams.
They also noted that among patients with heterogeneously dense or extremely dense breasts, White women were 14 percent more likely than Black women to receive preoperative MRI (60.3 percent vs. 46.3 percent). For women with lobular histology, the study authors pointed out that Black women were over 15 percent less likely than White women to receive preoperative MRI (47.3 percent vs. 62.6 percent).
“Given that the American Society of Breast Surgeons consensus guidelines recommend consideration of preoperative MRI for patients with dense breasts and lobular histology to assess for more extensive, mammographically occult disease, it is concerning that Black patients may be consistently receiving less comprehensive evaluations than their White counterparts when presenting with these characteristics,” wrote lead study author Sara P. Ginzberg, M.D., M.S., who is affiliated with the Department of Surgery, the Penn Center for Cancer Care Innovation and the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and colleagues.
In regard to surgical management, the study authors also noted that Black women who did have a preoperative MRI were 57 percent less likely to need a second operation after an index procedure for breast cancer.
“The finding that preoperative MRI was associated with a significantly lower likelihood of having a second surgery among Black women suggests that there indeed may be a meaningful clinical disadvantage to Black women resulting from the unequal use of this imaging modality,” posited Ginzberg and colleagues. “This evidence brings additional nuance to the existing debate regarding whether preoperative MRI affects re-excision rates for patients undergoing lumpectomy.”
Three Key Takeaways
1. Disparity in preoperative MRI use. Black women with breast cancer are significantly less likely to receive preoperative MRI exams compared to White women. The study found that Black women were 46 percent less likely to receive preoperative MRI than White women.
2. Impact on patients with dense breasts and lobular histology. Among patients with heterogeneously dense or extremely dense breasts, White women were 14 percent more likely to receive preoperative MRI than Black women. Similarly, for patients with lobular histology, Black women were over 15 percent less likely to receive preoperative MRI compared to White women.
3. Surgical management and second operations. Black women who did receive preoperative MRI were 57 percent less likely to need a second operation after an initial procedure for breast cancer.
The study authors emphasized adherence to standardized protocols for preoperative MRI in patients with breast cancer.
“ … Standardizing the use of preoperative MRI may mitigate provider- and system-level biases and promote more equitable breast cancer care and outcomes,” added Ginzberg and colleagues.
(Editor’s note: For related content, see “Preoperative Breast MRI Identifies Additional Cancer in Nearly 25 Percent of Young Women with Breast Cancer,” “Can Pre-Op Ultrafast MRI Predict Upgrade of DCIS Lesions to Invasive Breast Cancer?” and “Can AI Facilitate Effective Triage for Supplemental Breast MRI After Negative Mammography Screening?”)
Beyond the inherent limitations of a retrospective, single-center study, the authors acknowledged the exclusion of patients with multicentric disease due to the challenges of addressing multiple biopsies and an additional MRI indication in this patient population. The researchers also noted that disparities affecting racial and ethnic minorities beyond non-Hispanic Black women were not explored in this study.
