title: Advanced imaging modalities in early stage breast cancer: preoperative use in the United States Medicare population.
abstract: BACKGROUND
  Guidelines for breast cancer staging exist, but adherence remains unknown. This study evaluates patterns of imaging in early stage breast cancer usually reserved for advanced disease.
  
  
  METHODS
  Surveillance Epidemiology, and End Results data linked to Medicare claims from 1992-2005 were reviewed for stage I/II breast cancer patients. Claims were searched for preoperative performance of computed tomography (CT), positron emission tomography (PET), bone scans, and brain magnetic resonance imaging (MRI) ("advanced imaging").
  
  
  RESULTS
  There were 67,874 stage I/II breast cancer patients; 18.8% (n=12,740) had preoperative advanced imaging. The proportion of patients having CT scans, PET scans, and brain MRI increased from 5.7% to 12.4% (P<0.0001), 0.8% to 3.4% (P<0.0001) and 0.2% to 1.1% (P=0.008), respectively, from 1992 to 2005. Bone scans declined from 20.1% to 10.7% (P<0.0001). "Breast cancer" (174.x) was the only diagnosis code associated with 62.1% of PET scans, 37.7% of bone scans, 24.2% of CT, and 5.1% of brain MRI. One or more symptoms or metastatic site was suggested for 19.6% of bone scans, 13.0% of CT, 13.0% of PET, and 6.2% of brain MRI. Factors associated (P<0.05) with use of all modalities were urban setting, breast MRI and ultrasound. Breast MRI was the strongest predictor (P<0.0001) of bone scan (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.44-1.86), Brain MRI (OR 1.74, 95% CI 1.15-2.63), CT (OR 2.42, 95% CI 2.12-2.76), and PET (OR 5.71, 95% CI 4.52-7.22).
  
  
  CONCLUSIONS
  Aside from bone scans, performance of advanced imaging is increasing in early stage Medicare breast cancer patients, with limited rationale provided by coded diagnoses. In light of existing guidelines and increasing scrutiny about health care costs, greater reinforcement of current indications is warranted.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Crivello
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
authors.forename: Kathryn
authors.initials: K
authors.lastname: Evers
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: Marcia
authors.initials: M
authors.lastname: Boraas
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016001:Confidence Intervals; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D016017:Odds Ratio; D049268:Positron-Emission Tomography / Q000639:trends*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000639:trends*; D014481:United States