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Area of Science:

  • Oncology
  • Radiology
  • Medical Practice

Background:

  • Supplemental breast cancer screening with MRI is recommended for women with ≥20% lifetime risk.
  • Understanding factors influencing screening recommendations is crucial for optimizing patient care.

Purpose of the Study:

  • To examine factors associated with screening breast MRI recommendations among primary care providers (PCPs), gynecologists (GYNs), and radiologists.
  • To identify differences in recommendation patterns across medical specialties.

Main Methods:

  • Sequential mixed-methods study involving quantitative surveys with clinical vignettes (N=72) and qualitative interviews (n=17).
  • Logistic regression analyzed clinician and practice factors influencing recommendations.
  • Directed content analysis of interviews explored decision-making processes.

Main Results:

  • GYNs and radiologists were significantly more likely than PCPs to recommend breast MRI for high-risk and very-high-risk patients.
  • Qualitative analysis revealed distinct phases in the clinical pathway: identifying high-risk women and referral for screening.
  • Barriers to risk assessment and scope of practice issues emerged as key themes, differing by specialty.

Conclusions:

  • Significant inter-specialty differences exist in supplemental breast cancer screening recommendations.
  • Multilevel interventions are necessary to enhance the identification and management of high-risk women, particularly by PCPs.