Women strongly prefer contrast-enhanced mammography over breast magnetic resonance imaging for supplemental screening, according to new patient survey data published Friday in the Journal of the American College of Radiology [1].

The two modalities offer radiologists additional tools when imaging women with dense breasts, at high risk of the disease, or with a genetic predisposition—scenarios that pose challenges for traditional mammography. Experts are urging members of the specialty to go beyond risk models or other clinical factors when selecting the best approach.

“Including patient preferences into the medical decision-making process will help providers understand what will encourage or deter a given woman to follow-up with recommended supplemental screening, and, most importantly, to choose which testing, if any, is most acceptable to her,” Wendie A. Berg, MD, PhD, with the University of Pittsburgh School of Medicine, and colleagues wrote June 30.

For the analysis, researchers contacted 579 women in early 2022 who had both a contrast-enhanced mammogram and breast MRI as part of an ongoing research study. They also mailed an invitation to complete an online survey, which was developed using an analytic hierarchy process, used to pinpoint patient preferences. A total of 222 individuals completed the questionnaire, for a response rate of 38%. Of those, researchers determined that 71% had a preference for contrast-enhanced mammography over MRI.

Breast positioning emerged as the most important criterion for 33% of respondents, followed by claustrophobia (17%), IV line placement (17%) and overall stress (18%). Meanwhile, patients emphasized noise level (4.5%), contrast injection (5%) and indifference (6%) least frequently, the survey found. The mammography preference was most prevalent among women who emphasized claustrophobia (97%), while MRI was No. 1 for those concerned about breast positioning (54%).

The analytic hierarchy process methodology helps to structure the decision-making process for choosing a modality, the authors noted. It does so by separating the problem into hierarchical criteria, which are compared against each other to calculate importance.

“This approach would allow a physician to review these criteria with a patient who has never experienced such tests and use responses to help the patient choose the appropriate screening for her (if any),” the authors noted. “Including patient preferences, as measured by an AHP-based model, provides insights on preference structure and differences among women eligible for supplemental screening beyond mammography,” they added later.