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

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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.

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Acknowledgments

This study used the linked SEER–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER–Medicare database. Drs. Ross and Gross receive support from Medtronic, Inc. to develop methods of clinical trial data sharing. Drs. Ross and Gross are members of a scientific advisory board for FAIR Health, Inc. Dr. Ma receives support from Celgene Corporation. No other authors have relationships to disclose. This work was supported by the National Cancer Institute (5R01CA149045) and the P30 Cancer Center Support Grant at the Yale Comprehensive Cancer Center (P30CA016359).

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Brigid K. Killelea & Anees B. Chagpar

  2. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA

    Brigid K. Killelea, Jessica B. Long, Anees B. Chagpar, Xiaomei Ma, Pamela R. Soulos, Joseph S. Ross & Cary P. Gross

  3. Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Jessica B. Long, Pamela R. Soulos, Joseph S. Ross & Cary P. Gross

  4. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Xiaomei Ma

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  1. Brigid K. Killelea
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  2. Jessica B. Long
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  4. Xiaomei Ma
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Correspondence to Cary P. Gross.

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Table 4 Administrative codes used for assessing exposure and outcomes
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Killelea, B.K., Long, J.B., Chagpar, A.B. et al. Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 141, 155–163 (2013). https://doi.org/10.1007/s10549-013-2656-1

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