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Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

  • Epidemiology
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Abstract

Existing evidence suggests that preoperative breast magnetic resonance imaging (MRI) might not improve surgical outcomes in the general breast cancer population. To determine if patients differentially benefit from breast MRI, we examined surgical outcomes—initial mastectomy, reoperation, and final mastectomy rates—among patients grouped by histologic type. We identified women diagnosed with early-stage breast cancer from 2004 to 2007 in the SEER-Medicare dataset. We classified patients as having invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), mixed ductal/lobular carcinoma (IDLC) or other histologic type. Medicare claims were used to identify breast MRI and definitive surgeries during the initial surgical treatment episode. We used propensity score methods to account for the differential likelihood of exposure to MRI. Of the 20,332 patients who met our inclusion criteria for this study, 12.2 % had a preoperative breast MRI. Patients with ILC as compared to other histologic groups were most likely to receive MRI [OR 2.32; 95 % CI (2.02–2.67)]. In the propensity score-adjusted analyses, breast MRI was associated with an increased likelihood of an initial mastectomy for all patients and among all histologic subgroups. Among patients with ILC, having a breast MRI was associated with lower odds of a reoperation [OR 0.59; 95 % CI (0.40–0.86)], and an equal likelihood of a final mastectomy compared to similar patients without a breast MRI. Overall and among patients with IDC and IDLC, breast MRI was not significantly associated with a likelihood of a reoperation but was associated with greater odds of a final mastectomy. Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning; it does not provide evidence for the routine use of breast MRI among all newly diagnosed breast cancer patients or among patients with IDC.

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Acknowledgments

This work was supported by funding from the National Cancer Institute (5R25CA116339). This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors would like to thank Seth Tyree and Huan Liu for assistance in creating the initial dataset, and Keith Amos for insight into initial surgical treatment episode and for helping to define the types of breast cancer surgeries.

Conflict of interest

The authors state that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, CB#7411, Chapel Hill, NC, 27599, USA

    Alice K. Fortune-Greeley, Stephanie B. Wheeler, Andrea K. Biddle & William R. Carpenter

  2. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 411 West Chapel Hill Street Suite 600, Durham, NC, 27701, USA

    Alice K. Fortune-Greeley

  3. Lineberger Comprehensive Cancer Center, University of North Carolina, CB#7293, Chapel Hill, NC, USA

    Stephanie B. Wheeler, Anne-Marie Meyer, Katherine E. Reeder-Hayes, Hyman B. Muss & William R. Carpenter

  4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, CB#7435, Chapel Hill, NC, 27599, USA

    Anne-Marie Meyer

  5. Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB#7590, Chapel Hill, NC, 27599, USA

    Anne-Marie Meyer & William R. Carpenter

  6. Division of Oncology, School of Medicine, University of North Carolina, CB#7305, Chapel Hill, NC, 27599, USA

    Katherine E. Reeder-Hayes & Hyman B. Muss

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  1. Alice K. Fortune-Greeley
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Correspondence to Alice K. Fortune-Greeley.

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Fortune-Greeley, A.K., Wheeler, S.B., Meyer, AM. et al. Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study. Breast Cancer Res Treat 143, 203–212 (2014). https://doi.org/10.1007/s10549-013-2787-4

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