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Preoperative breast MRI and mortality in older women with breast cancer

  • Epidemiology
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The survival benefit from detecting additional breast cancers by preoperative magnetic resonance imaging (MRI) continues to be controversial.


We followed a cohort of 4454 women diagnosed with non-metastatic breast cancer (stage I–III) from 2/2005–6/2010 in five registries of the breast cancer surveillance consortium (BCSC). BCSC clinical and registry data were linked to Medicare claims and enrollment data. We estimated the cumulative probability of breast cancer-specific and all-cause mortality. We tested the association of preoperative MRI with all-cause mortality using a Cox proportional hazards model.


917 (20.6%) women underwent preoperative MRI. No significant difference in the cumulative probability of breast cancer-specific mortality was found. We observed no significant difference in the hazard of all-cause mortality during the follow-up period after adjusting for sociodemographic and clinical factors among women with MRI (HR 0.90; 95% CI 0.72–1.12) compared to those without MRI.


Our findings of no breast cancer-specific or all-cause mortality benefit supplement prior results that indicate a lack of improvement in surgical outcomes associated with use of preoperative MRI. In combination with other reports, the results of this analysis highlight the importance of exploring the benefit of preoperative MRI in patient-reported outcomes such as women’s decision quality and confidence levels with decisions involving treatment choices.

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This research was supported by a National Cancer Institute-funded grant R01CA149365. Data collection for this work was additionally supported, in part, by funding of the Breast Cancer Surveillance Consortium from the National Cancer Institute (P01CA154292, U54CA163303). The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. You can learn more about the breast cancer surveillance consortium at:


This research was supported by a National Cancer Institute-funded grant R01CA149365. Data collection for this work was additionally supported, in part, by funding of the Breast Cancer Surveillance Consortium from the National Cancer Institute (P01CA154292, U54CA163303).

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Authors and Affiliations



TO, WZ, JW, MG, AT, WD, BV, LH, DB, KW, KK, and RH conceived of the study. TO, WZ, JW and RH analyzed and interpreted the data. TO, JW, and MG helped to draft the manuscript. TO, WZ, JW, MG, AT, WD, BV, LH, DB, KW, KK, and RH participated in the study design and coordination, and helped to interpret the data. TO, WZ, JW, MG, AT, WD, BV, LH, DB, KW, KK, and RH helped with editing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to M. Goodrich.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethics approval and consent to participate

All participating registry sites within the BCSC received institutional review board approval for either active or passive consenting processes or a waiver of consent to enroll participants, link data, and perform analytic studies. All procedures are Health Insurance Portability and Accountability Act compliant and all registries and the SCC have received a Federal Certificate of Confidentiality and other protections for the identities of women, physicians, and facilities involved in this research.


Appendix A

See Fig. 2.

Fig. 2
figure 2

Conceptual model for the relation between preoperative MRI and mortality

Appendix B

See Table 4.

Table 4 Procedure codes used in this analysis

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Onega, T., Zhu, W., Weiss, J.E. et al. Preoperative breast MRI and mortality in older women with breast cancer. Breast Cancer Res Treat 170, 149–157 (2018).

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