Women with a much-higher-than-average risk of breast cancer usually follow an aggressive breast cancer screening plan. Women at very high risk could have an abnormal breast cancer gene (BRCA1 or BRCA2), a very strong family history of breast cancer, or a personal history of breast cancer.
Breast MRI (magnetic resonance imaging), along with mammogram and breast ultrasound, often are recommended as part of an aggressive screening plan. Other research has shown the value of screening with breast MRI for high-risk women. This is especially true for young women with dense breasts because screening mammograms may be less effective at identifying early-stage cancer in dense breasts.
Researchers found many women at high-risk for breast cancer for whom MRI screening was recommended refused to have breast MRI. The researchers were surprised that so many women refused and wanted to know why. These results were presented at the 2009 San Antonio Breast Cancer Symposium.
In another study looking at breast cancer screening in high-risk women (which included breast MRI), more than 42% of the women (512 out of 1,215) refused to have breast MRI. The 512 women gave the following reasons for refusing breast MRI:
- 25.4% of the women said claustrophobia -- fear of being in a very small space -- was the main reason; breast MRI is usually done in a scanner that requires a woman to lie still in a tight space
- 20.0% of the women said travel and time demands were the main reason; high demand and limited availability can make scheduling and traveling to a breast MRI challenging
- 12.1% of the women said financial concerns were the main reason; this seems odd because the study was paying for all study-related testing
Still, breast MRI is expensive. Even with insurance, out-of-pocket costs can be high. People without insurance coverage for breast MRI may view the cost of breast MRI as out of their reach.
Other reasons for refusing breast MRI were:
- didn't see the need for MRI
- not wanting to get an injection during the MRI
- concerns about follow-up testing that might be required
The reasons the women gave for not getting an MRI are understandable. Still, other research has clearly shown that frequent breast cancer screening using multiple techniques -- mammograms, ultrasounds, and MRIs -- is the best approach for high-risk women to ensure that if breast cancer develops, the cancer is found at an early, more treatable stage.
If an aggressive breast cancer screening plan is recommended to you, you may have concerns similar to the women in this study. Still, your screening plan is about keeping you healthy, so you may want to consider these points:
- If getting an MRI or mammogram is uncomfortable, scary, or painful for you, ask your doctor and technicians how the procedure can be made as easy and as comfortable as possible for you.
- If you're having problems scheduling a mammogram, MRI, or ultrasound, call the National Cancer Institute (800-4-CANCER) or the American College of Radiology (800-227-5463) to find certified imaging centers near you.
- If you're worried about cost, travel time, or the effect on your family or job of having an MRI, ask your doctor, a local hospital social worker, testing center staff members, or someone in your work's personnel office for advice and help. They can help you find a way around any obstacles you may be facing.
- Tell your doctor about any concerns you have. Make sure your doctor explains the reasons why a particular screening method is recommended for you. Make sure you understand the benefits and risks of your screening plan. Ask about your options -- your screening plan can be modified to meet your needs and preferences.
- In between screening tests, remember to perform regular breast self-exam. Tell your doctor right away if you find anything you're concerned about. The Breastcancer.org Five Steps of a Breast Self-Exam page has information on how to do a self-exam.