Poor compliance despite equal access: Military experience with screening breast MRI in high risk women

Background: Using the military as a model for an equal-access, no-cost healthcare system, we sought to (1) describe screening breast MRI compliance rates and (2) identify patient-perceived barriers to screening. Methods: In this retrospective cohort study of a prospectively maintained database at a tertiary level center, we compared compliance among women at ≥20% risk of developing breast cancer (Tyrer-Cuzick) and conducted structured phone interviews with women at ≥30% risk. Results: From 2015 to 2016, 1,052 women met criteria for screening MRI. Of these, only 251 (24%) underwent MRI screening. Compliance among women with a 20–24%, 25–29%, 30–39%, and ≥40% risk was 16%, 24%, 37%, and 51%, respectively (p < 0.02). 37 of 128 unique patients (29%) with ≥30% risk agreed to interview. 43% cited time/inconvenience as the key barrier to screening; 22% cited questions regarding screening recommendations; and only 3% cited fear/concerns as the key barrier. Conclusions: Even in an equal-access system, there is poor compliance in patients who are at high risk for developing breast cancer. Patients cited time/inconvenience and questions regarding screening as key barriers to screening.