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Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer

Onega, Tracy PhD; Weiss, Julia E. MS; Buist, Diana S.M. PhD; Tosteson, Anna N.A. ScD; Henderson, Louise M. PhD; Kerlikowske, Karla MD; Goodrich, Martha E. MS; O’Donoghue, Cristina MD; Wernli, Karen J. PhD; DeMartini, Wendy B. MD; Virnig, Beth A. PhD; Bennette, Caroline S. PhD; Hubbard, Rebecca A. PhD

doi: 10.1097/MLR.0000000000000542
Brief Reports

Purpose: We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast magnetic resonance imaging (MRI) use among older women.

Materials and Methods: Using SEER-Medicare data from 2004 to 2010, we identified women with and without breast MRI as part of their diagnostic and preoperative breast cancer workup and measured the number and sequence of breast imaging and biopsy events per woman.

Results: A total of 10,766 (20%) women had an MRI in the diagnostic/preoperative period, 32,178 (60%) had mammogram and ultrasound, and 10,669 (20%) had mammography alone. MRI use increased across study years, tripling from 2005 to 2009 (9%–29%). Women with MRI had higher rates of breast imaging and biopsy compared with those with mammogram and ultrasound or those with mammography alone (5.8 vs. 4.1 vs. 2.8, respectively). There were 4254 unique sequences of breast events; the dominant patterns for women with MRI were an MRI occurring at the end of the care pathway. Among women receiving an MRI postdiagnosis, 26% had a subsequent biopsy compared with 51% receiving a subsequent biopsy in the subgroup without MRI.

Conclusions: Older women who receive breast MRI undergo additional breast imaging and biopsy events. There is much variability in the diagnostic/preoperative work-up in older women, demonstrating the opportunity to increase standardization to optimize care for all women.

*Department of Biomedical Data Science

Norris Cotton Cancer Center

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH

§Group Health Research Institute, Seattle, WA

Department of Radiology, University of North Carolina, Chapel Hill, NC

Departments of Medicine and Epidemiology and Biostatistics

#Veterans Affairs, General Internal Medicine Section, University of California, San Francisco, CA

**Comprehensive Breast Program, Department of Women’s Oncology, H. Lee Moffitt Cancer Center, Tampa, FL

††Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI

‡‡School of Public Health, University of Minnesota, Minneapolis, MN

§§Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Supported by funding from the National Institutes of Health, National Cancer Institute under grant R01 CA149365-01.

The authors declare no conflict of interest.

Reprints: Martha E. Goodrich, MS, Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756. E-mail: martha.e.goodrich@dartmouth.edu.

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