Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer

Breast Cancer Res Treat. 2013 Aug;141(1):155-63. doi: 10.1007/s10549-013-2656-1. Epub 2013 Aug 14.

Abstract

While there has been increasing interest in the use of preoperative breast magnetic resonance imaging (MRI) for women with breast cancer, little is known about trends in MRI use, or the association of MRI with surgical approach among older women. Using the Surveillance, Epidemiology and End Results-Medicare database, we identified a cohort of women diagnosed with breast cancer from 2000 to 2009 who underwent surgery. We used Medicare claims to identify preoperative breast MRI and surgical approach. We evaluated temporal trends in MRI use according to age and type of surgery, and identified factors associated with MRI. We assessed the association between MRI and surgical approach: breast-conserving surgery (BCS) versus mastectomy, bilateral versus unilateral mastectomy, and use of contralateral prophylactic mastectomy. Among the 72,461 women in our cohort, 10.1 % underwent breast MRI. Preoperative MRI use increased from 0.8 % in 2000-2001 to 25.2 % in 2008-2009 (p < 0.001). Overall, 43.3 % received mastectomy and 56.7 % received BCS. After adjustment for clinical and demographic factors, MRI was associated with an increased likelihood of having a mastectomy compared to BCS (adjusted odds ratio = 1.21, 95 % CI 1.14-1.28). Among women who underwent mastectomy, MRI was significantly associated with an increased likelihood of having bilateral cancer diagnosed (9.7 %) and undergoing bilateral mastectomy (12.5 %) compared to women without MRI (3.7 and 4.1 %, respectively, p < 0.001 for both). In conclusion, the use of preoperative breast MRI has increased substantially among older women with breast cancer and is associated with an increased likelihood of being diagnosed with bilateral cancer, and more invasive surgery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / economics
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / prevention & control
  • Breast Neoplasms / surgery
  • Female
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / statistics & numerical data
  • Magnetic Resonance Imaging / economics
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Mastectomy / economics
  • Mastectomy / methods
  • Mastectomy / statistics & numerical data*
  • Mastectomy, Segmental / economics
  • Mastectomy, Segmental / statistics & numerical data
  • Medicare / economics
  • Medicare / statistics & numerical data*
  • Neoplasm Invasiveness
  • Neoplasm Staging / economics
  • Neoplasm Staging / methods
  • Neoplasm Staging / statistics & numerical data
  • Neoplasms, Multiple Primary / diagnosis*
  • Neoplasms, Multiple Primary / economics
  • Neoplasms, Multiple Primary / surgery
  • Preoperative Care / economics
  • Preoperative Care / statistics & numerical data*
  • Preoperative Care / trends
  • SEER Program / statistics & numerical data
  • Sensitivity and Specificity
  • Socioeconomic Factors
  • United States