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

• Type of Material: Article
• Authors: Monica Morrow, Memorial Sloan-Kettering Cancer Center; Sarah T. Hawley, University of Michigan Medical School; M. Chandler McLeod, University of Michigan School of Public Health; Ann S. Hamilton, Keck School of Medicine of USC; Kevin Ward, Emory University; Steven J. Katz, University of Michigan Medical School; Reshma Jagsi, University of Michigan Medical School
• Language: English
• Date: 2017-07-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Society of Surgical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-017-5840-4
• Title of Journal or Parent Work: Annals of Surgical Oncology
• ISSN: 1068-9265
• Volume: 24
• Issue: 7
• Start Page: 1889
• End Page: 1896
• Grant/Funding Information: 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.; This work was funded by grant No. P01 CA163233 to the University of Michigan from the National Cancer Institute.
• Keywords: Attitude of Health Personnel; Follow-Up Studies; Adult; Patient Selection; Aged; Magnetic Resonance Imaging; Surgeons; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Aged, 80 and over; Humans; Surveys and Questionnaires; Prognosis; Male; SEER Program; Female; Practice Patterns, Physicians'; Middle Aged; Clinical Decision-Making
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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.