Preoperative breast magnetic resonance imaging and contralateral breast cancer occurrence among older women with ductal carcinoma in situ.
Although preoperative magnetic resonance imaging (MRI) can detect mammographically occult contralateral breast cancers (CBCs) among women with ductal carcinoma in situ (DCIS), the impact of MRI on the incidence of subsequent CBC events is unclear. We examined whether MRI use decreases CBC occurrences and detection of invasive disease among women who develop a CBC. Utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset, we assessed overall, synchronous (<6 months after primary cancer diagnosis), and subsequent (≥6 months after diagnosis, i.e., metachronous) CBC occurrence in women aged 67-94 years diagnosed with DCIS during 2004-2009, with follow-up through 2011. We applied a matched propensity score approach to compare the stage-specific incidence rate of CBC according to MRI use. Our sample consisted of 9166 beneficiaries, 1258 (13.7 %) of whom received preoperative MRI. After propensity score matching, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (108.6 vs. 29.7 per 1000 person-years; hazard ratio [HR] = 3.65; p < .001) with no significant differences in subsequent CBC rate (6.7 vs. 6.8 per 1000 person-years; HR = 0.90; p = .71). The 6-year cumulative incidence of any CBC (in situ plus invasive) remained significantly higher among women undergoing MRI, compared with those not undergoing MRI (9 vs. 4 %, p < .001). Women undergoing MRI also had a higher incidence of invasive CBC (4 vs. 3 %, p = .04). MRI use resulted in an increased detection of synchronous CBC but did not prevent subsequent CBC occurrence, suggesting that many of the undetected CBC lesions may not become clinically evident.
Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA. shiyi.wang@yale.edu.|Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA. shiyi.wang@yale.edu.
Shi-Yi
http://orcid.org/0000-0002-3294-5784
SY
Wang
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Jessica B
JB
Long
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
Brigid K
BK
Killelea
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
Suzanne B
SB
Evans
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
Kenneth B
KB
Roberts
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Andrea
A
Silber
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.|Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Cary P
CP
Gross
D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011300:Preoperative Care; D057216:Propensity Score; D012189:Retrospective Studies; D018426:SEER Program
Contralateral breast cancer occurrence; Ductal carcinoma in situ; Early detection; Magnetic resonance imaging; Overdiagnosis