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Growing Use of Preop MRI Scanning Found to Increase Rate of Invasive Breast Cancer Surgeries

By MedImaging International staff writers
Posted on 02 Sep 2013

Heavy use of magnetic resonance imaging (MRI) may be leading to needless breast removal in older women with breast cancer, according to new research.

The study’s findings were published online August 14, 2013, of Breast Cancer Research and Treatment. “These data are concerning because the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear,” said the study’s lead author Cary Gross, MD, associate professor of internal medicine at Yale School of Medicine (New Haven, CT, USA) and director of the Cancer Outcomes, Public Policy, and Effectiveness Research [COPPER] Center at Yale Cancer Center. “Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit of the more aggressive option.”

The researchers monitored the use of breast MRI scanning and surgical care of 72,461 female US Medicare beneficiaries age 67–94, who were diagnosed with breast cancer during the years 2000 to 2009.

The investigators discovered a substantial surge in the use of preoperative breast MRI over the study period from 1% in 2000-2001 to 25% in 2008-2009. The researchers also found that women who received an MRI were more likely to subsequently undergo more aggressive surgical treatment. In women who received mastectomy, 12.5% of those who had MRI received bilateral mastectomy, whereas only 4.1% of those who did not have MRI had bilateral mastectomy.

The study also revealed that women undergoing MRI were more likely to have a contralateral prophylactic mastectomy. Among women who underwent mastectomy, 6.9% of women who had an MRI underwent contralateral prophylactic mastectomy, compared to 1.8% in women who did not have an MRI scan.

“There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age,” said Brigid Killelea, MD, assistant professor of surgery at Yale School of Medicine, and first author on the study. “Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer.”

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65 (528.81240844727): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

66 (89.883804321289): select jos_twitters.link from jos_twitters where cat=10

67 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

68 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

69 (46.014785766602): select jos_linkedin.link from jos_linkedin where cat=10

70 (70.095062255859): SELECT fid FROM jos_deeppockets WHERE id=294748040 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748040 AND published='1' LIMIT 1

71 (51.021575927734): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

72 (505.92422485352): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (427.9613494873): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (83.92333984375): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 3408.1935882568): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (74.863433837891): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (46.968460083008): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (69.856643676758): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 2714.8723602295): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

107 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

108 (68.187713623047): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (662.80364990234): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

111 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

112 (55.074691772461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (563.14468383789): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (663.99574279785): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (438.92860412598): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

117 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

118 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

120 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

121 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

122 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

123 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

124 (267.02880859375): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 43889.045715332): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (532.15026855469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748040 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748040 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (51.021575927734): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (36.954879760742): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (32.186508178711): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (!!!!! 5769.9680328369): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (633.95500183105): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (!!!!! 5064.0106201172): SELECT name FROM jos_deeppockets WHERE id=212

140 (99.897384643555): SELECT name FROM jos_deeppockets WHERE id=212

141 (717.1630859375): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (494.00329589844): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (329.01763916016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

144 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

145 (!!!!! 14202.117919922): TRUNCATE TABLE jos_trademed_module

146 (87.02278137207): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (52.928924560547): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (904.08325195312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

151 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

152 (!!!!! 1152.0385742188): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

154 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

155 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748040 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748040 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

157 (29.087066650391): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

158 (36.001205444336): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

160 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748040 AND published='1' LIMIT 1

161 (49.114227294922): select jos_twitters.link from jos_twitters where cat=10

162 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

163 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

164 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

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