Breast MRI utilization in older patients with newly diagnosed breast cancer

Abstract

Background: Recently, use of advanced imaging modalities, such as MRI, has increased dramatically. One novel but still evolving use for MRI is in the diagnosis and clinical staging of newly diagnosed breast cancer patients. Compared with mammography, MRI is more sensitive, but less specific, and far more expensive. The purpose of this study is to examine the prevalence and predictors of MRI use for clinical staging in older women with newly diagnosed breast cancer.

Materials and methods: SEER-Medicare data were used to identify incident breast cancer cases between 2003 and 2005. Outpatient Medicare claims data were queried for receipt of breast MRI. Multivariate logistic regression analyses were performed to examine associations between receiving MRI and patient demographics, clinical characteristics, and SEER region.

Results: A total of 46,824 patients with breast cancer met inclusion criteria. MRI use increased from 3.9% of women diagnosed in 2003 to 10.1% of women diagnosed in 2005. In the bivariate analyses race, urban/rural location, SEER region, poverty level, education level, stage, surgery type, and tumor size were all significantly associated with receipt of MRI. In the multivariate analysis, those who were younger, white, living in more metropolitan areas, and living in wealthier areas were more likely to receive MRI. There was substantial variability in odds of MRI among different SEER regions.

Conclusions: Breast MRI for patients with newly diagnosed breast cancer in the SEER-Medicare population is increasingly common. Ongoing examination of the dissemination of technology is critical to understanding current practice patterns and to the development and implementation of future guidelines.

FIG. 1

Percent of incident breast cancer cases receiving MRI by year.

FIG. 2

Percent of incident breast cancer cases receiving breast MRI by SEER region.