In a previous post, I discussed the controversy surrounding the new recommended guidelines suggesting that routine mammography screening for breast cancer should start at age 50, instead of the previously recommended age of 40.

Breast cancer affects around 194,000 people in the U.S. each year, and causes around 40,000 deaths. The most common screening exam for breast cancer is a mammogram, which is used to detect and evaluate breast changes in women who may have or have not any complaints or symptoms.

However, for women at high or intermediate risk for breast cancer, some tumors may be missed by mammograms or even ultrasound screening. Therefore, M.R.I (Magnetic Resonance Imaging) is often recommended for them. The procedure involves an injection with a contrast agent and spending about 30 minutes in a closed machine. A study published this month in the journal Radiology suggests that a large number of women with elevated breast cancer risk decide, however, to skip MRI screening for various reasons.

The study included 1,215 women who were eligible for breast MRI screening according to the latest protocol guidelines. But only 703 of them (57.9%) agreed to an M.R.I. Of the 512 that refused to get it:

• 130 (25.4%) refused owing to claustrophobia
• 93 (18.2%) owing to time constraints
• 62 (12.1%) owing to financial concerns
• 47 (9.2%) because their physician would not provide a referral and/or did not believe MR imaging was indicated
• 40 (7.8%) because they were not interested
• 39 (7.6%) because they were medically intolerant to MR imaging
• 29 (5.7%), because they did not want to undergo intravenous injection
• 27 (5.3%) owing to additional biopsy or other procedures that might be required subsequently
• 21 (4.1%) owing to MR imaging scheduling constraints
• 11 (2.2%) because of the travel required
• 7 (1.4%) owing to gadolinium-related risks or allergies
• 6 (1.2%) for unknown reasons

The good news is that those women with a 25% or greater lifetime risk of breast cancer were 1.5 times more likely to accept the M.R.I. than those that had a lower risk.

Doctors highly recommend M.R.I. screening for women at high-risk of breast cancer because it is very sensitive in detecting tumors. However, unless concerns related to claustrophobia, time constraints, and insurance coverage are addressed, this procedure is likely to continue to be underused.