Patterns and Predictors of Referral for Screening Breast MRI: A Mixed-Methods Study

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.