Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics

Shruthi Ram, Nandini Sarma, Javier E Lopez, Yu Liu, Chin-Shang Li, Shadi Aminololama-Shakeri

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. Materials and Methods: Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. Results: Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P <.0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P <.0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS). Conclusion: Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.

Original languageEnglish (US)
Pages (from-to)594-600
Number of pages7
JournalJournal of the American College of Radiology
Volume15
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Breast
Demography
Hispanic Americans
Oceanic Ancestry Group
Breast Density
North American Indians
Research Ethics Committees

Keywords

  • Breast density legislation
  • dense breasts
  • disparities
  • racial
  • screening breast MRI
  • supplemental screening

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{c25a9ea70d274c8f9861d971b9cc5aee,
title = "Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics",
abstract = "Purpose: To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. Materials and Methods: Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. Results: Screening MRI examinations with breast density as the indication increased from 8.5{\%} (32 of 376) to 21.1{\%} (136 of 646, P <.0001) after BDL. When high-risk patients were excluded, the increase was from 8{\%} to 17.2{\%} (P <.0001). Patient demographics before and after BDL were, by race: white 71.8{\%} versus 71.2{\%}; Asian 6.4{\%} versus 10.5{\%}; black 3.7{\%} versus 3.1{\%}; American Indian 0.3{\%} versus 1.4{\%}; Native Hawaiian or Pacific Islander 1.6{\%} versus 1.7{\%}; by ethnicity: Hispanic or Latino 10.6{\%} versus 7.9{\%}. Before and after BDL, predominantly female providers (81.4{\%} and 77.4{\%}, P = not significant [NS]) and specialists (62.5{\%} and 63.5{\%}, P = NS) ordered the majority of breast MRI examinations compared with males (18.6{\%} and 22.6{\%}, P = NS). Conclusion: Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.",
keywords = "Breast density legislation, dense breasts, disparities, racial, screening breast MRI, supplemental screening",
author = "Shruthi Ram and Nandini Sarma and Lopez, {Javier E} and Yu Liu and Chin-Shang Li and Shadi Aminololama-Shakeri",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.jacr.2017.12.001",
language = "English (US)",
volume = "15",
pages = "594--600",
journal = "Journal of the American College of Radiology",
issn = "1558-349X",
publisher = "Elsevier BV",
number = "4",

}

TY - JOUR

T1 - Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics

AU - Ram, Shruthi

AU - Sarma, Nandini

AU - Lopez, Javier E

AU - Liu, Yu

AU - Li, Chin-Shang

AU - Aminololama-Shakeri, Shadi

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Purpose: To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. Materials and Methods: Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. Results: Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P <.0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P <.0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS). Conclusion: Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.

AB - Purpose: To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. Materials and Methods: Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. Results: Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P <.0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P <.0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS). Conclusion: Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.

KW - Breast density legislation

KW - dense breasts

KW - disparities

KW - racial

KW - screening breast MRI

KW - supplemental screening

UR - http://www.scopus.com/inward/record.url?scp=85044133339&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044133339&partnerID=8YFLogxK

U2 - 10.1016/j.jacr.2017.12.001

DO - 10.1016/j.jacr.2017.12.001

M3 - Article

C2 - 29622173

AN - SCOPUS:85044133339

VL - 15

SP - 594

EP - 600

JO - Journal of the American College of Radiology

JF - Journal of the American College of Radiology

SN - 1558-349X

IS - 4

ER -