Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer.
Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions.
Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina.
Louise M
LM
Henderson
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Julie
J
Weiss
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.|Department of Biostatistics, University of Washington, Seattle, Washington.
Rebecca A
RA
Hubbard
Moffitt Cancer Center, Tampa, Florida.
Cristina
C
O'Donoghue
Department of Radiology, University of Wisconsin, Madison, Wisconsin.
Wendy B
WB
DeMartini
Group Health Research Institute, Seattle, Washington.
Diana S M
DS
Buist
Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.|General Internal Medicine Section, Department of Veterans Affairs, University of California at San Francisco, San Francisco, California.
Karla
K
Kerlikowske
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Martha
M
Goodrich
School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
Beth
B
Virnig
The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Anna N A
AN
Tosteson
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Constance D
CD
Lehman
The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Tracy
T
Onega
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008408:Mastectomy; D006278:Medicare / Q000706:statistics & numerical data; D011300:Preoperative Care; D018426:SEER Program; D012923:Social Class; D016896:Treatment Outcome; D014481:United States
breast magnetic resonance imaging; ductal carcinoma in situ; invasive breast cancer; preoperative