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Onega T, Tosteson ANA, Weiss J, Alford-Teaster J, Hubbard RA, Henderson LM, Kerlikowske K, Goodrich ME, O'Donoghue C, Wernli KJ, DeMartini WB, Virnig BA. Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis. BMC Health Serv Res 2016; 16:76. [PMID: 26920552 PMCID: PMC4769533 DOI: 10.1186/s12913-016-1317-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI). METHODS Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005-2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics. RESULTS Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % (N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs. $1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138). CONCLUSION Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Anna N A Tosteson
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Julie Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. .,Department of Veterans Affairs, General Internal Medicine Section, University of California, San Francisco, CA, USA.
| | - Martha E Goodrich
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | | | | | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Beth A Virnig
- School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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Bitencourt AGV, Pereira NP, França LKL, Silva CB, Paludo J, Paiva HLS, Graziano L, Guatelli CS, Souza JA, Marques EF. Role of MRI in the staging of breast cancer patients: does histological type and molecular subtype matter? Br J Radiol 2015; 88:20150458. [PMID: 26374470 DOI: 10.1259/bjr.20150458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the role of MRI in the pre-operative staging of patients with different histological types and molecular subtypes of breast cancer, by the assessment of the dimensions of the main tumour and identification of multifocal and/or multicentric disease. METHODS The study included 160 females diagnosed with breast cancer who underwent breast MRI for pre-operative staging. The size of the primary tumour evaluated by MRI was compared with the pathology (gold standard) using the Pearson's correlation coefficient (r). The presence of multifocal and/or multicentric disease was also evaluated. RESULTS The mean age of patients was 52.6 years (range 30-81 years). Correlation between the largest dimension of the main tumour measured by MRI and pathology was worse for non-special type/invasive ductal carcinoma than for other histological types and was better for luminal A and triple-negative than for luminal B and Her-2 molecular subtypes. Multifocal and/or multicentric disease was present in 48 patients (30.0%), and it was more common in breast carcinomas classified as Her-2 molecular subtype. There was no statistically significant difference in the frequency of multifocal and/or multicentric tumours identified only by MRI in relation to histological type or molecular subtype. CONCLUSION The results of this retrospective study demonstrated that histological types and molecular subtypes might influence the MRI assessment of breast cancers, especially in the evaluation of tumour size. ADVANCES IN KNOWLEDGE The real benefit of MRI for treatment planning in patients with breast cancer may be different according to the histological type and molecular subtype.
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Affiliation(s)
| | - Nara P Pereira
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Luciana K L França
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Caroline B Silva
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Jociana Paludo
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Hugo L S Paiva
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Luciana Graziano
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Camila S Guatelli
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Juliana A Souza
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
| | - Elvira F Marques
- Department of Diagnostic Imaging, A C Camargo Cancer Center, São Paulo, Brazil
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Della Corte GA, Rocco N, Sabatino V, Rispoli C, Riccardi A, Falco G, Pezzulo C, Romano F, Compagna R, Amato B, Accurso A. Increase of mastectomy rates after preoperative MRI in women with breast cancer is not influenced by patients age. Int J Surg 2014; 12 Suppl 2:S44-S46. [PMID: 25159548 DOI: 10.1016/j.ijsu.2014.08.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
Preoperative magnetic resonance imaging (MRI) is increasingly used for staging women with breast cancer, including screening for occult ipsilateral or contralateral cancer. If breast-conserving surgery is planned, a MRI examination should be performed in all ages women with suspected breast cancer, especially those exhibiting dense or heterogeneously dense breast parenchyma, for which the sensitivity of both ultrasonography and mammography is low. MRI staging causes more extensive breast surgery in a significative proportion of women by identifying additional cancer. If the ability to find additional occult cancer is the true value of MRI, this is not influenced by patients' ages. For this reason, preoperative MRI should be counseled to all women with breast cancer by clinicians, independently from the age, as the age alone does not preclude additional findings.
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Affiliation(s)
- Gianni Antonio Della Corte
- Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy.
| | - Nicola Rocco
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Vincenzo Sabatino
- Department of Advanced Biomedical Sciences - Section of Imaging, University Federico II of Naples, Italy.
| | - Corrado Rispoli
- Department of General Surgery - ASL NA1, Cardinale Ascalesi Hospital, Naples, Italy.
| | - Albina Riccardi
- Department of Advanced Biomedical Sciences - Section of Imaging, University Federico II of Naples, Italy.
| | - Giuseppe Falco
- Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80, 42120 Reggio Emilia, Italy.
| | - Carmine Pezzulo
- 5th Department of General Surgery, Second University of Naples, Naples, Italy.
| | - Federica Romano
- Department of Advanced Biomedical Sciences - Section of Imaging, University Federico II of Naples, Italy.
| | - Rita Compagna
- Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy.
| | - Bruno Amato
- Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy.
| | - Antonello Accurso
- Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy.
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