Skip to main content

Advertisement

Log in

The association of preoperative breast magnetic resonance imaging and multiple breast surgeries among older women with early stage breast cancer

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

To evaluate the association between preoperative breast magnetic resonance imaging (MRI) utilization and the rate of multiple surgeries, and to investigate the extent of any variation of rates of multiple surgeries among physicians. We identified patients with stage 0, I, or II breast cancer diagnosed between 2002 and 2007 in the Surveillance, Epidemiology, and End Results-Medicare database. Using diagnosis and procedure codes, we defined that the initial treatment episode had ended when a gap in surgery occurred at least 90 days after primary surgery. Surgical procedures of partial mastectomy or mastectomy during the initial treatment period were calculated to identify patients who received multiple surgeries. Multilevel logistic regression models were used to identify patient- and physician-level predictors of multiple surgeries. Of 45,453 women with early stage breast cancer who were treated by 2,595 surgeons during the study period, 9,462 patients (20.8 %) received multiple breast surgeries; of these patients, 8,318 (87.9 %) underwent one additional surgery, 988 (10.4 %) received two additional surgeries, and 156 (1.6 %) received three or more additional surgeries. Among 2,997 (6.6 % of the entire cohort) women who underwent preoperative breast MRI evaluation, 770 received multiple breast surgeries. After we adjusted for patient and tumor characteristics associated with multiple surgeries, we found that the rate of multiple surgeries was not significantly different between the two groups with or without preoperative breast MRI. Furthermore, the median odds ratio of 2.0, corresponding with the median value of the relative odds of receiving multiple surgeries between two randomly chosen physicians after controlling for other confounders, indicated a large individual surgeon effect. Substantial variation was observed in the rates of multiple surgeries in women aged 66 and older with early stage breast cancer. Evidence does not support that preoperative breast MRI reduces the incidence of multiple surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lee MC, Rogers K, Griffith K et al (2009) Determinants of breast conservation rates: reasons for mastectomy at a comprehensive cancer center. Breast J 15(1):34–40

    Article  PubMed  Google Scholar 

  2. McCahill LE, Single RM, Aiello Bowles EJ et al (2012) Variability in reexcision following breast conservation surgery. JAMA 307(5):467–475

    Article  PubMed  Google Scholar 

  3. Kotwall C, Ranson M, Stiles A et al (2007) Relationship between initial margin status for invasive breast cancer and residual carcinoma after re-excision. Am Surg 73(4):337–343

    PubMed  Google Scholar 

  4. Waljee JF, Hu ES, Newman LA et al (2008) Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol 15(5):1297–1303

    Article  PubMed  Google Scholar 

  5. Menes TS, Tartter PI, Bleiweiss I et al (2005) The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol 12(11):881–885

    Article  PubMed  Google Scholar 

  6. Morrow M, Jagsi R, Alderman AK et al (2009) Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA 302(14):1551–1556

    Article  PubMed  CAS  Google Scholar 

  7. Cellini C, Hollenbeck ST, Christos P et al (2004) Factors associated with residual breast cancer after reexcision for close or positive margins. Ann Surg Oncol 11(10):915–920

    Article  PubMed  CAS  Google Scholar 

  8. Subhas G, Shah AJ, Gupta A et al (2011) Review of third and fourth re-excision for narrow or positive margins of invasive and intraductal carcinoma. Int Surg 96(1):18–20

    Article  PubMed  Google Scholar 

  9. Wang SY, Virnig BA, Tuttle TM et al (2012) Variability of preoperative breast MRI utilization among older women with newly diagnosed early-stage breast cancer. Breast J (in press)

  10. Lehman CD, DeMartini W, Anderson BO et al (2009) Indications for breast MRI in the patient with newly diagnosed breast cancer. J Natl Compr Canc Netw 7:193–201

    PubMed  Google Scholar 

  11. Hwang N, Schiller DE, Crystal P et al (2009) Magnetic resonance imaging in the planning of initial lumpectomy for invasive breast carcinoma: its effect on ipsilateral breast tumor recurrence after breast-conservation therapy. Ann Surg Oncol 16(11):3000–3009

    Article  PubMed  Google Scholar 

  12. Bleicher RJ, Ciocca RM, Egleston BL et al (2009) The association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg 209(2):180–187

    Article  PubMed  Google Scholar 

  13. Turnbull L, Brown S, Harvey I et al (2010) Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 375:563–571

    Article  PubMed  Google Scholar 

  14. Houssami N, Ciatto S, Macaskill P et al (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26(19):3248–3258

    Article  PubMed  Google Scholar 

  15. Vanderwalde LH, Dang CM, Bresee C et al (2011) Discordance between pathologic and radiologic tumor size on breast MRI may contribute to increased re-excision rates. Am Surg 77(10):1361–1363

    PubMed  Google Scholar 

  16. Blair SL, Thompson K, Rococco J et al (2009) Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg 209(5):608–613

    Article  PubMed  Google Scholar 

  17. Azu M, Abrahamse P, Katz SJ et al (2010) What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol 17(2):558–563

    Article  PubMed  Google Scholar 

  18. SEER-Medicare Linked Database. http://healthservices.cancer.gov/seermedicare/overview/. Accessed 20 Sept 2010

  19. Bach PB, Guadagnoli E, Schrag D et al (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40(8 Suppl IV):19–25

    Google Scholar 

  20. Friese CR, Neville BA, Edge SB et al (2009) Breast biopsy patterns and outcomes in Surveillance, Epidemiology, and End Results-Medicare data. Cancer 115(4):716–724

    Article  PubMed  Google Scholar 

  21. Klabunde CN, Warren JL, Legler JM (2002) Assessing comorbidity using claims data: an overview. Med Care 40(8 Suppl IV):26–35

    Google Scholar 

  22. Baldwin LM, Adamache W, Klabunde CN et al (2002) Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement. Med Care 40(8 Suppl IV):82–95

    Google Scholar 

  23. Larsen K, Merlo J (2005) Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 161:81–88

    Article  PubMed  Google Scholar 

  24. Miller BT, Abbott AM, Tuttle TM (2011) The influence of preoperative MRI on breast cancer treatment. Ann Surg Oncol, e-pub ahead of print

  25. Pengel KE, Loo CE, Teertstra HJ et al (2008) The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study. Breast Cancer Res Treat 116(1):161–169

    Article  PubMed  Google Scholar 

  26. Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119(2):415–422

    Article  PubMed  CAS  Google Scholar 

  27. Brennan ME, Houssami N, Lord S et al (2009) Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 27(33):5640–5649

    Article  PubMed  Google Scholar 

  28. Desch CE, McNiff KK, Schneider EC et al (2008) American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures. J Clin Oncol 26(21):3631–3637

    Article  PubMed  Google Scholar 

  29. Talsma AK, Reedijk AM, Damhuis RA et al (2011) Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals. Eur J Surg Oncol 37(4):357–363

    Article  PubMed  CAS  Google Scholar 

  30. Yeh ED (2010) Breast magnetic resonance imaging: Current clinical indications. Magn Reson Imaging Clin N Am 18(2):155–169, vii

    Google Scholar 

  31. Morrow M, Freedman G (2006) A clinical oncology perspective on the use of breast MR. Magn Reson Imaging Clin N Am 14(3):363–78, vi

    Google Scholar 

  32. Orel SG, Reynolds C, Schnall MD et al (1997) Breast carcinoma: MR imaging before re-excisional biopsy. Radiology 205(2):429–436

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

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. The authors of this paper are responsible for its content. This research is supported by the Doctoral Dissertation Fellowship Award (to S.-Y. Wang) from the University of Minnesota Graduate School. At the time of the study, the corresponding author (S.-Y. W.) was a PhD student, Division of Health Policy and Management, University of Minnesota School of Public Health.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shi-Yi Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, SY., Kuntz, K.M., Tuttle, T.M. et al. The association of preoperative breast magnetic resonance imaging and multiple breast surgeries among older women with early stage breast cancer. Breast Cancer Res Treat 138, 137–147 (2013). https://doi.org/10.1007/s10549-013-2420-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-013-2420-6

Keywords

Navigation