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 language | English (US) |
|---|---|
| Pages (from-to) | 594-600 |
| Number of pages | 7 |
| Journal | Journal of the American College of Radiology |
| Volume | 15 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2018 |
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Keywords
- Breast density legislation
- dense breasts
- disparities
- racial
- screening breast MRI
- supplemental screening
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics. / Ram, Shruthi; Sarma, Nandini; Lopez, Javier E; Liu, Yu; Li, Chin-Shang; Aminololama-Shakeri, Shadi.
In: Journal of the American College of Radiology, Vol. 15, No. 4, 01.04.2018, p. 594-600.Research output: Contribution to journal › Article
}
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 -