Screening Breast MRI and Genetic Testing Utilization in High-risk Population: Analysis of National Health Interview Survey.

OBJECTIVE

For individuals at increased risk of breast cancer, additional tests, such as screening breast MRI and genetic testing, are recommended. We assessed the utilization of screening breast MRI and genetic testing among high-risk individuals and identified associated patient factors.

METHODS

This retrospective, cross-sectional study used 2023 National Health Interview Survey data. Women aged 25 or older with at least 1 first-degree relative diagnosed with breast cancer before age 50 were included. A survey weight was applied to generate weighted samples representing national estimates. Multivariable logistic regression analysis was used to identify factors associated with screening breast MRI, genetic test discussions, and genetic test completion.

RESULTS

The weighted sample included 6 851 757 women (unweighted n = 920) (mean age, 60.2; 3.1% [199 883/6 486 458] Asian, 14.4% [932 502/6 486 458] Black, 78.1% [5 063 194/6 486 458] White, and 4.4% [290 879/6 486 458] other races). Overall, 12.5% (855 463/6 851 757) were of Hispanic ethnicity. Screening MRI use was reported by 7.9% (506 672/6 417 453) , while 28.8% (1 963 524/6 822 303) discussed and 17.7% (1 209 406/6 830 229) completed genetic testing. Having 2 or more first-degree relatives with breast cancer increased the likelihood of screening MRI (odds ratio [OR], 2.94; 95% CI, 1.56-5.54) and genetic testing completion (OR, 2.74; 95% CI, 1.68-4.48). The odds of discussing genetic testing were lower for Black individuals (OR, 0.43; 95% CI, 0.20-0.91) and those with Medicaid or no insurance (OR, 0.45; 95% CI, 0.23-0.87). Concern about medical bills was associated with lower odds of genetic testing completion (OR, 0.54; 95% CI, 0.33-0.90).

CONCLUSIONS

Screening breast MRI and genetic testing are underutilized among high-risk women. Expanding insurance coverage and provider education may help increase uptake of recommended screening practices.