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Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Usage of magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is increasing, despite scant evidence that it improves outcomes. Little is known about the knowledge, perspectives, and clinical characteristics of surgeons associated with MRI use.

Methods

Women with early-stage breast cancer undergoing definitive surgery between July 2013 and August 2015 were identified from the Los Angeles and Georgia Surveillance, Epidemiology and End Results (SEER) registries and were asked to name their attending surgeons. The 489 surgeons were sent a questionnaire; 77% (n = 377) responded. Questions that addressed the likelihood of ordering an MRI in different scenarios were used to create a scale to measure surgeon propensity for MRI use. Knowledge and practice characteristics also were assessed.

Results

Mean surgeon age was 54 years, 25% were female, and median number of years in practice was 21. Wide MRI use variation was observed, with 26% obtaining MRI for a clinical stage I screen-detected breast cancer and 72% for infiltrating lobular cancer. High users of MRI were significantly more likely to be higher-volume surgeons (p < 0.001) and to have misconceptions about MRI benefits (p < 0.001). Of surgeons who felt they used MRI more often, 60% were high MRI users; only 6% were low MRI users.

Conclusions

Our findings suggest relatively frequent use of MRI, even in uncomplicated clinical scenarios, in the absence of evidence of benefit, and use was more common among high-volume surgeons. A substantial number of surgeons who are high MRI users harbor misconceptions about MRI benefit, suggesting an opportunity for education and consensus building regarding appropriate use.

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Acknowledgement

Cancer incidence data collection was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the NCI’s Surveillance Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California (USC), and contract HHSN261201000034C awarded to the Public Health Institute. Cancer incidence data collection in Georgia was supported by contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the authors. The State of California, Department of Public Health, the NCI, and the CDC and their Contractors and Subcontractors had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We acknowledge our project staff (Mackenzie Crawford and Kiyana Perrino from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, and Renee Bickerstaff-Magee from USC; Rebecca Morrison, Alexandra Jeanpierre, Stefanie Goodell, Rose Juhasz, Kent Griffith, and Irina Bondarenko from the University of Michigan). We acknowledge with gratitude our survey respondents.

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    Authors and Affiliations

    1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

      Monica Morrow MD

    2. Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA

      Sarah T. Hawley PhD, MPH & Steven J. Katz MD, MPH

    3. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA

      Sarah T. Hawley PhD, MPH & Steven J. Katz MD, MPH

    4. Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, MI, USA

      Sarah T. Hawley PhD, MPH

    5. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA

      M. Chandler McLeod PhD, MS

    6. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

      Ann S. Hamilton PhD

    7. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

      Kevin C. Ward PhD

    8. Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, MI, USA

      Reshma Jagsi MD, DPhil

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    1. Monica Morrow MD
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    Correspondence to Monica Morrow MD.

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    DISCLOSURES

    The authors have no conflict of interest disclosures to report. This work was funded by Grant No. P01 CA163233 to the University of Michigan from the National Cancer Institute.

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    Steven J. Katz and Reshma Jagsi have equally contributed to this work.

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    Morrow, M., Hawley, S.T., McLeod, M.C. et al. Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer. Ann Surg Oncol 24, 1889–1896 (2017). https://doi.org/10.1245/s10434-017-5840-4

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    • DOI: https://doi.org/10.1245/s10434-017-5840-4

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