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Lee MV, Aharon S, Kim K, Sunn Konstantinoff K, Appleton CM, Stwalley D, Olsen MA. Recent Trends in Screening Breast MRI. JOURNAL OF BREAST IMAGING 2021; 4:39-47. [PMID: 35103253 PMCID: PMC8794012 DOI: 10.1093/jbi/wbab088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to assess trends in screening breast MRI utilization among privately insured women in the U.S. from 2007 to 2017. METHODS The utilization of screening breast MRI among women aged 25-64 years from January 1, 2007, to December 31, 2017, was obtained using the MarketScan Commercial Database. We used Current Procedural Terminology codes to exclude breast MRI exams performed in women with a new breast cancer diagnosis and in women imaged to assess response to neoadjuvant therapy in the preceding 90 days. During the 11-year study, 351 763 study-eligible women underwent 488 852 MRI scans. RESULTS An overall 55.0% increase in screening breast MRI utilization was observed over the study period, with a steadily increasing trend. The greatest annual increase in percent utilization was from 2007 to 2008 at 16.6%. The highest utilization rate was in 2017, in which 0.4% of women aged 25-64 years underwent screening breast MRI. Of the women who underwent screening MRI with sufficient follow-up, 76.5% underwent only one examination during the study period. CONCLUSION Utilization of screening breast MRI has increased steadily in the past decade to a peak of 0.4% of adult women. However, an estimated 9% of U.S. women are eligible for high-risk breast MRI screening; thus, utilization falls short of optimal compliance. Further studies to evaluate the barriers to screening compliance may help optimize utilization.
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Affiliation(s)
- Michelle V Lee
- Medical College of Georgia, Department of Radiology, Augusta, GA, USA,Address correspondence to M.V.L. (e-mail: )
| | - Shani Aharon
- Medical School at the University of Massachusetts, Worcester, MA, USA
| | - Kevin Kim
- Washington University in St. Louis, Department of Medicine, St. Louis, MO, USA
| | | | | | - Dustin Stwalley
- Washington University in St. Louis, Department of Medicine, St. Louis, MO, USA
| | - Margaret A Olsen
- Washington University in St. Louis, Department of Medicine, St. Louis, MO, USA
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Dimitrakopoulos FID, Kottorou A, Antonacopoulou AG, Makatsoris T, Kalofonos HP. Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem. J Breast Cancer 2015; 18:207-17. [PMID: 26472970 PMCID: PMC4600684 DOI: 10.4048/jbc.2015.18.3.207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/20/2015] [Indexed: 01/06/2023] Open
Abstract
Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.
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Affiliation(s)
| | - Anastasia Kottorou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Anna G Antonacopoulou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Thomas Makatsoris
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Haralabos P Kalofonos
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
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Pilewskie M, Hirsch A, Eaton A, Stempel M, Gemignani ML. Breast Cancer in the Elderly: Is MRI Helpful? Breast J 2015; 21:651-7. [PMID: 26400412 DOI: 10.1111/tbj.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Appropriate use of magnetic resonance imaging (MRI) in elderly breast cancer (BC) patients remains unclear; we sought to identify the indications and implications of MRI use in our elderly BC population. Women 70 years of age or older at first BC diagnosis with an MRI performed at our institution either perioperatively or in follow-up were included from a prospectively maintained database from 2000 to 2010. Univariate logistic regression was used to test associations with disease identified by MRI only (additional ipsilateral, contralateral, or new cancer) following perioperative MRI. 305 BCs were imaged in 286 patients. 133 were imaged with MRI in the perioperative setting alone, 88 had only follow-up MRIs after BC treatment, and 65 had both. Indications for perioperative MRI include: extent of disease evaluation (181; 91%); occult primary (10; 5%); high-risk screening (5; 3%); and abnormal physical exam with negative conventional imaging (2; 1%). Disease identified by MRI only for occult primary cases was 4/10 (40%; 95% confidence interval: 12.2-73.8%) and 14/181 (7.7%; 95% confidence interval: 4.3-12.6%) for perioperative MRIs performed for extent of disease evaluation. Analysis of imaging and tumor characteristics failed to find significant predictors of disease identified by MRI only. A total of 369 post-treatment follow-up MRIs were performed in 148 patients with a median of 2 MRIs per patient (range 1-8), with seven cases of disease identified by MRI only (1.9%; 95% confidence interval: 0.8-3.9%). MRI had the greatest benefit in women presenting with an occult primary cancer and minimal additional benefit in elderly patients with BC undergoing MRI imaging for extent of disease evaluation or in post-treatment surveillance.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Hirsch
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Chatzidaki P, Mellos C, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol 2010; 18:923-31. [PMID: 21107743 DOI: 10.1245/s10434-010-1389-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE There has been much controversy regarding the optimal management of breast cancer in very elderly women. Some clinicians are reluctant to offer surgical treatment for women older than aged 80 years because of the assumed higher operative risk associated with advanced age. This study was designed to investigate the perioperative complications of breast cancer surgery in women of this age group. METHODS Data were reviewed of all women ≥80 years of age who underwent breast cancer surgery at a university clinic during the period 1990-2005. Symptoms, comorbidities, preoperative risk assessment, type of operation, postoperative histological diagnosis, hospital stay, morbidity, and mortality were documented and analyzed. RESULTS During this 16-year period, 140 operations for breast cancer were performed in 129 women. The majority of the patients (37.9%) underwent a modified radical mastectomy, 32.1% underwent a simple mastectomy, 24.3% underwent breast-conserving therapy, and 5.7% underwent an axillary lymph node dissection. Complications occurred in 37.1% of the cohort: 31.4% were minor complications and only 5.7% were major. Intraoperative morbidity was 18.6% and postoperative morbidity was 20%. Late complications occurred in 5% of patients. The most common complications were associated with the wound region (50%). The perioperative mortality in this group of elderly women was zero. CONCLUSIONS Breast cancer surgery has acceptable perioperative morbidity and mortality in women aged ≥80 years. Surgery is the cornerstone of breast cancer treatment and should be offered as first-line treatment for all patients regardless of their age.
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Affiliation(s)
- Paraskevi Chatzidaki
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Chatzidaki P, Mellos C, Briese V, Mylonas I. Does primary breast cancer in older women (≥80 years) have unfavorable histological characteristics? Arch Gynecol Obstet 2010; 284:705-12. [PMID: 20949358 DOI: 10.1007/s00404-010-1697-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although the majority of breast cancer patients are older than 65 years, limited data exist regarding the pathological features in very elderly patients. The aim of this study was to evaluate the histological characteristics of breast cancer in women aged over 80 years. METHODS The histological data were reviewed for 137 women aged 80 years and older who were diagnosed with primary breast carcinoma at a university clinic during the period 1990-2005. RESULTS Although it is believed that older women have more advanced tumor, the majority of the tumors were assessed as stage I (35%) and II (32.9%). Mucinous, papillary, medullary, tubular, and cribriform histological subtypes have been demonstrated often in this age group (16.8%). In 49.7 and 70.6% of cases, respectively, there were no regional lymph node metastases and no distant metastases. The frequency of ER-positive (72%) and PR-positive (56%) tumors in these patients is high. CONCLUSIONS An accurate prognostic evaluation at the time of initial diagnosis is of high importance for older patients, since this could avoid unnecessary and risky therapies. As an increasing number of women ≥80 years old may be diagnosed with breast cancer in the coming years, treatment in this specific age group should be individualized to the patient and tumor factors.
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Affiliation(s)
- Paraskevi Chatzidaki
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Jatoi I, Chen BE, Anderson WF, Rosenberg PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 2007; 25:1683-90. [PMID: 17404367 DOI: 10.1200/jco.2006.09.2106] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Since 1990, overall breast cancer mortality rates in the United States decreased 24%. This decline has been attributed to mammography screening and adjuvant systemic therapy. However, the efficacy of these modalities may depend on estrogen receptor (ER) expression and age. We therefore examined breast cancer mortality trends in the United States according to ER status and age. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) program (1990-2003), we calculated trends in incidence-based mortality (IBM), annual hazard rates for breast cancer deaths after diagnosis, and relative hazard rates for women with ER-positive and ER-negative tumors. Relative hazard rates were assessed with Cox proportional hazards models, adjusted for stage and grade, and stratified by age at diagnosis. RESULTS During the study period, IBM and annual hazard rates for breast cancer deaths decreased among women with ER-positive and ER-negative tumors, although declines were greater for those with ER-positive tumors. Among women younger than 70 years, relative hazard rates declined 38% for those with ER-positive tumors versus 19% for those with ER-negative tumors. Among women 70 years or older, relative hazard rates declined 14% for those with ER-positive tumors versus no significant decline for those with ER-negative tumors. CONCLUSION In the United States, breast cancer mortality rates have declined among women with ER-positive and ER-negative tumors, with greater declines among younger women and those with ER-positive tumors. Although mortality in all groups remains unacceptably high, additional emphasis should be placed on improving outcomes of breast cancer patients older than 70 years and those of all ages with ER-negative tumors.
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Affiliation(s)
- Ismail Jatoi
- Department of Surgery, National Naval Medical Center and Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA.
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James PD, Manuel DG, Mao Y. Avoidable mortality across Canada from 1975 to 1999. BMC Public Health 2006; 6:137. [PMID: 16716230 PMCID: PMC1481505 DOI: 10.1186/1471-2458-6-137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 05/23/2006] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The concept of 'avoidable' mortality (AM) has been proposed as a performance measure of health care systems. In this study we examined mortality in five geographic regions of Canada from 1975 to 1999 for previously defined avoidable disease groups that are amenable to medical care and public health. These trends were compared to mortality from other causes. METHODS National and regional age-standardized mortality rates for ages less than 65 years were estimated for avoidable and other causes of death for consecutive periods (1975-1979, 1980-1985, 1985-1989, 1990-1994, and 1995-1999). The proportion of all-cause mortality attributable to avoidable causes was also determined. RESULTS From 1975-1979 to 1995-1999, the AM decrease (46.9%) was more pronounced compared to mortality from other causes (24.9%). There were persistent regional AM differences, with consistently lower AM in Ontario and British Columbia compared to the Atlantic, Quebec, and Prairies regions. This trend was not apparent when mortality from other causes was examined. Injuries, ischaemic heart disease, and lung cancer strongly influenced the overall AM trends. CONCLUSION The regional differences in mortality for ages less than 65 years was attributable to causes of death amenable to medical care and public health, especially from causes responsive to public health.
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Affiliation(s)
- Paul D James
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Canada
- The Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Canada
- The Department of Public Health Sciences, Faculty of Medicine, University of Toronto, 155 College Street, Toronto, Canada
| | - Doug G Manuel
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Canada
- The Department of Public Health Sciences, Faculty of Medicine, University of Toronto, 155 College Street, Toronto, Canada
| | - Yang Mao
- The Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Canada
- Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Tunney's Pasture, Ottawa, Canada
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Kang SB. Medical Treatment of Early Breast Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2006. [DOI: 10.5124/jkma.2006.49.8.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soon-beom Kang
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Korea.
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