title: Patient age and preoperative breast MRI in women with breast cancer: biopsy and surgical implications.
abstract: BACKGROUND
  The influence of patient age on multidisciplinary treatment planning after preoperative breast magnetic resonance imaging (MRI) and its influence on the surgical decision-making process are unclear.
  
  
  METHODS
  We performed a retrospective review of 710 women with breast cancer who underwent preoperative MRI at our institution between January 2003 and December 2008. Analysis by patient age included the number of additional ipsilateral MRI findings, the number of biopsies recommended/performed, the number of additional cancers found, and the percentage of patients undergoing mastectomy.
  
  
  RESULTS
  Of the 710 patients, 343 (48%) had additional ipsilateral MRI findings. After stratifying by age, the incidence of additional ipsilateral findings differed between decades (P = 0.004). However, fewer biopsies were recommended in older patients (P = 0.043). The number of women pursuing preoperative needle biopsy increased with age (P = 0.0018), while the incidence of a second focus of breast cancer did not change with age (P = 0.07). The mastectomy rate decreased from 65% in women younger than 50 to 40% in women older than 70 (P < 0.001).
  
  
  CONCLUSIONS
  In the setting of newly diagnosed breast cancer, the value of MRI is not influenced by patient age, with at least 40% of women in all age groups having additional findings on MRI. Insisting on preoperative needle biopsy of additional findings may decrease mastectomy rates. Further study is needed to determine the reasons for the increased percentage of mastectomies in younger women.
authors.affiliation: Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Adkisson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Vallow
authors.forename: Kristin
authors.initials: K
authors.lastname: Kowalchik
authors.forename: Rebecca
authors.initials: R
authors.lastname: McNeil
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hines
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Deperi
authors.forename: Alvaro
authors.initials: A
authors.lastname: Moreno
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.forename: Edith A
authors.initials: EA
authors.lastname: Perez
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies