Uptake and Consequences of MRI for Breast Cancer Screening in Community Settings

The objective of this project is to characterize the use, clinical outcomes and economic consequences of magnetic resonance imaging (MRI) for breast cancer screening in the community. Recent clinical guidelines have expanded recommendations for screening breast MRI potentially affecting over one million women. Screening breast MRI offers higher sensitivity compared with mammography but lower specificity and much higher cost. Originally studied in high-risk groups and controlled settings, MRI performance may differ dramatically when used in broader populations. Our research aims are to: 1) Characterize over a decade of screening breast MRI use in a community setting; 2) Quantify clinical outcomes and use of follow-up testing; and 3) Evaluate the economic consequences of screening breast MRI. We will analyze electronic health data from women receiving breast MRI from 2000-2013 at Atrius Health, a large multi-center group practice in Massachusetts serving nearly 600,000 patients. Results will be integrated into a decision-analytic simulation model of breast cancer epidemiology to assess the cost-effectiveness of screening breast MRI as practiced in the community. Analysis of population-based electronic health data combined with decision-analytic modeling provides a powerful means to address important and timely questions in cancer prevention and control.

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