Abstract PD16-01: Racial Disparities in the Use of Preoperative Breast MRI after Breast Cancer Diagnosis
Authors: Ginzberg Sara P. , Grady Connor B. , Fayanju Oluwadamilola (Lola) , Edmonds Christine E. 
Published: March 2023

Introduction: The use of magnetic resonance imaging (MRI) prior to surgical treatment for breast cancer has greatly increased over the past decade. As MRI more accurately defines disease extent vs mammography and sonography, it is frequently utilized for staging women at elevated risk of occult disease due to young age, dense breast tissue, and/or lobular histology. However, it is not known whether women from different racial backgrounds and socioeconomic statuses have equal access to preoperative breast MRI. The goal of this study was to assess whether the use of preoperative breast MRI varies by race and insurance type.

Methods: We identified adult women who were diagnosed with Stage 0-III breast cancer within our mixed academic/community health system between 2016-2019 and were subsequently treated with surgical resection. We limited our analysis to non-Hispanic Black and non-Hispanic White women, as they comprised 93% of the eligible cohort. Patients who underwent breast MRI between their date of diagnosis and date of surgery were considered to have had a “preoperative MRI.” We used multivariable logistic regression to quantify the association between patient factors and receipt of preoperative MRI. Covariates included patient race, insurance type, age, year of diagnosis, clinical stage, histology, breast density, receptor subtype, and receipt of neoadjuvant systemic therapy.

Results: 1,268 women met inclusion criteria and had complete clinical information available for analysis. 362 (29%) were Black, and 906 (71%) were White. 718 (57%) had private insurance, 460 (36%) had Medicare, and 72 (6%) had Medicaid. Compared to White patients, a larger proportion of Black patients had Medicaid (15% vs. 2.0%), fatty or scattered density (i.e., level 1 or 2) breasts (69% vs 48%), and regional disease (26% vs 19%) (Table). Patients with Medicare had the highest proportion of fatty or scattered density breasts (67% vs private=46% vs Medicaid=56%), while patients with Medicaid had the highest proportion of regional disease (35% vs private=23% vs Medicare=15%).

The proportion of patients who received preoperative MRI was higher for White (49%) vs Black women (37%, p&lt; 0.001). After adjustment, Black patients were 52% less likely to undergo preoperative MRI compared to White patients (OR 0.48, 95% CI 0.35-0.66, p&lt; 0.001). Compared to privately-insured patients, patients with Medicare had a similar likelihood of undergoing preoperative MRI (OR 0.81, 95% CI 0.54-1.22, p=0.309), while patients with Medicaid may have had a lower likelihood of undergoing preoperative MRI (OR 0.55, 95% CI 0.30-1.00, p=0.053).

Conclusions: Black patients with newly diagnosed breast cancer were less likely than White patients to undergo preoperative breast MRI, a disparity that persisted after controlling for insurance and clinical factors. Algorithmic use of preoperative MRI may mitigate provider- and system-level biases and promote more equitable resource utilization.

Table 1: Characteristics of patients with non-metastatic breast cancer, diagnosed and treated at our institution (2016-2019) *Biomarker data for 2019 cohort is pending

Citation Format: Sara P. Ginzberg, Connor B. Grady, Oluwadamilola (Lola) Fayanju, Christine E. Edmonds. Racial Disparities in the Use of Preoperative Breast MRI after Breast Cancer Diagnosis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD16-01.