Radiology providers should add contrast-enhanced mammography to address breast MRI access gaps

Radiology providers should consider adding contrast-enhanced mammography to address poor patient access to breast MRI, according to new research published Monday.

About half of women may require supplemental breast imaging beyond regular screening, due to factors such as dense tissue or elevated family risk. However, many may lack access to these services, which can include MRI or ultrasound, Neiman Policy Institute experts detailed in the American Journal of Preventive Medicine [1].

On average, American women need to travel about 8 miles to reach the closest mammography screening facility. But they would need to drive about 22 miles to reach a breast ultrasound provider and 23 miles for breast MRI, with disparities along racial and socioeconomic divides.

The findings are based on an analysis of data covering 29,629 ZIP codes and their relation to the closest breast imaging facilities.

“Economics are unlikely to support bringing MR screening equally close to all women who qualify for it. Given this reality, other options to mitigate the impact of these differences on outcomes need to be pursued,” Eric W. Christensen, PhD, research director at the Neiman Institute, and co-authors wrote Aug. 12. “To this end, contrast-enhanced mammography can be offered as an add-on technology at facilities with existing mammography capabilities using the same equipment at costs substantially less than the costs associated with breast MR. As with all new technologies, some training would be required, and radiologist engagement is needed to oversee the administration of contrast agents.”

While this approach might not solve differences in breast MRI access, it has the potential to “mitigate the more important outcome differences” such as mortality, the authors added. That’s because contrast-enhanced mammography has demonstrated comparable performance to MRI. Besides expanding CEM access at existing mammography facilities, other options could include patient education and transportation support.

For the study, researchers examined the distance between ZIP codes and the nearest breast imaging facility using 2023 data from the Food and Drug Administration and American College of Radiology. They also further controlled for factors such as Area Deprivation Index, urbanicity and population size.

Average distance to breast MR facilities was nearly three times farther than to mammography, the authors reported. There also were “substantial” differences in distance when comparing urban areas and other geographies. For instance, compared with metropolitan areas, the additional miles to a breast MR facility for small, rural areas was about 23 miles. Compared to the most advantaged areas as measured by the Area Deprivation Index, additional distance from the least advantaged areas to ZIP codes with the nearest facility was “substantially” higher for breast MR and ultrasound (12.2 miles and 11.5 miles, respectively) than for mammography (2.4 miles). For those in metro areas, breast MR was twice as far as mammography while in small/rural locations, MR was three times as far.

“Such distance differences may contribute to disparities associated with rural residence, including lower screening rates, more late-stage breast cancer diagnoses, and lower cancer survival,” the authors noted.