Most women are opting for advanced breast imaging exams — even if it means paying out-of-pocket.

That’s what researchers at Beth Israel Deaconess Medical Center and Harvard Medical School found in a new study, which shows most women — especially ones with dense breasts — are unsatisfied with only undergoing mammography for breast cancer assessment.

They also do not appear to be concerned with the risks involved with breast MR and contrast-enhanced mammography (CEM), including adverse contrast reactions, false positives and unnecessary biopsies.

“Prior to our study, little was known about whether asymptomatic patients in the general screening population would accept the associated downsides and risks related to contrast-enhanced imaging, despite improved cancer detection, compared to conventional mammography,” wrote Dr. Daniel Son and co-authors, with the division of breast imaging at Beth Israel Deaconess Medical Center and Harvard Medical School.

Out of nearly 1,000 patients scheduled at a single institute for a mammogram, only 34.7% said they were satisfied with their breast screening plan. More than half said they would pay $250-$500 for an MR exam, especially if they had dense breasts. A further 10.3% with dense breasts indicated they would pay $500-$1,000.

A majority was not concerned with CEM radiation exposure (70.3%), contrast reaction (75.4%), IV line placement (82.2%), claustrophobia (67.4%), and false positives (70.7%). Those with a prior breast MR or CEM exam were less concerned about allergic reactions, IV and claustrophobia.

More than half had dense breast tissue, and out of this group, 49.6% were called back, 29% had a benign biopsy and 13.7% had a prior CEM/MR exam. Those with a previous benign biopsy or MR/CEM exam were not as worried about false positives.

Dr. Stamatia Destounis, director of clinical research at mammography practice Elizabeth Wende Breast Care, who was not involved in the study, told HCB News that while interesting, more research is needed. "I wonder if in this survey we have a somewhat biased group of women from one institution only, that have a high number of callbacks and benign biopsies, do not trust mammography only and are already knowledgeable about contrast enhanced studies. I believe a multi-institutional study or survey would be helpful to validate these results."

While supplemental imaging is desired, breast MR is limited by high costs and low availability, while CEM is new and requires radiation. Mammography is still considered the gold standard for screening, according to the authors.

The findings were published in Academic Radiology.