Abstract
Background
Preoperative use of breast magnetic resonance imaging (MRI) in women with breast cancer may increase rates of mastectomy. This study investigated relationships between breast MRI and therapeutic and contralateral prophylactic mastectomy (CPM) in women with breast cancer.
Methods
A total of 3606 women diagnosed with stage 0–III breast cancer from 1998 through 2000 (n = 1743; early period) or from 2003 through 2005 (n = 1863; late period) were retrospectively identified. Patient demographic and clinical characteristics were obtained from our institution’s tumor registry. MRI use in the diagnostic evaluation was obtained from a prospective radiology database. Rates of therapeutic mastectomy, CPM, and associations with breast MRI were compared between the two time periods by multiple logistic regressions controlling for disease stage, age, family history, and calendar year of diagnosis.
Results
A total of 14.2% of women underwent MRI, 29.0% had mastectomy, and 5.3% had CPM. Use of breast MRI increased substantially between the two time periods (4.1% to 23.7%, P < 0.001). Mastectomy rates increased from 28% to 30% (P > 0.05). The rate of CPM increased by >50% from the early to late period (4.1% to 6.4%, P < 0.002). Women who underwent MRI were nearly twice as likely to have CPM (9.2 vs. 4.7%, P < 0.001). Multivariate models found MRI was associated with increased rates of CPM for women with stage I or II disease (odds ratio 2.04, P = 0.001).
Conclusions
MRI changes the surgical treatment of breast cancer among subsets of women diagnosed with breast cancer, suggesting there are hidden monetary and nonmonetary costs associated with its use.
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References
Morris EA, Liberman L, Ballon DJ, Robson M, Abramson AF, Heerdt A, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol. 2003;181:619–26.
Smith RA. The evolving role of MRI in the detection and evaluation of breast cancer. N Engl J Med. 2007;356:1362–4.
Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468–73.
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49.
Bilimoria KY, Cambic A, Hansen NM, Bethke KP. Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers. Arch Surg. 2007;142:441–5.
Deurloo EE, Peterse JL, Rutgers EJ, Besnard APE, Muller SH, Gilhuijs KGA. Additional breast lesions in patients eligible for breast-conserving therapy by MRI: impact on preoperative management and potential benefit of computerised analysis. Eur J Cancer. 2005;41:1393–401.
Grobmyer SR, Mortellaro VE, Marshall J, Higgs GM, Hochwald SN, Mendenhall NP, et al. Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy? J Am Coll Surg. 2008;206:1045–50; discussion 1050–2.
Katipamula R, Hoskin TL, Boughey JC, Degnim AC, Grant CS, Brandt KR, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative MRI. J Clin Oncol. 2008;26:509.
Liberman L, Morris EA, Kim CM, Kaplan JB, Abramson AF, Menell JH, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol. 2003;180:333–41.
Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295–303.
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.
Graves KD, Peshkin BN, Halbert CH, DeMarco TA, Isaacs C, Schwartz MD. Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors. Breast Cancer Res Treat. 2007;104:321–9.
Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon M, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.
Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol. 2003;180:901–10.
Hede K. Possible MRI-mastectomy link sparks debate on MRI’s role in breast cancer management. J Natl Cancer Inst. 2008;100:1052–4.
Bleicher RJ, Morrow M. MRI and breast cancer: role in detection, diagnosis, and staging. Oncology (Williston Park). 2007;21:1521–8, 1530.
Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T. The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol. 2004;14:1725–31.
Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD. Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol. 2008;26:386–91.
Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton MB, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23:4275–86.
Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2004:CD002748.
Peters NH, Borel Rinkes IH, Mali WP, van den Bosch MA, Storm RK, Plaisier PW, et al. Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome—MONET—study. Trials. 2007;8:40.
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Sorbero, M.E.S., Dick, A.W., Beckjord, E.B. et al. Diagnostic Breast Magnetic Resonance Imaging and Contralateral Prophylactic Mastectomy. Ann Surg Oncol 16, 1597–1605 (2009). https://doi.org/10.1245/s10434-009-0362-3
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DOI: https://doi.org/10.1245/s10434-009-0362-3