MRI Utilization in Newly Diagnosed Breast Cancer: A Survey of Practicing Surgeons

Abstract

Whereas guidelines supporting breast MRI in high-risk screening exist, guidelines for MRI use in newly diagnosed breast cancer are lacking. We, therefore, conducted a study of breast surgeons to determine practice beliefs surrounding MRI use in newly diagnosed breast cancer. A survey sent to 2,274 American Society of Breast Surgeons members in December 2010 queried routine MRI use (defined as >75% of time) in specific clinical scenarios. Analyses were performed by respondent practice setting, practice volume, and practice specialization. Descriptive statistics and subgroup analysis using a χ(2) and logistic regression were used. Responses from 1,012 surgeons (45.5% response rate) were eligible for analysis. Respondents represented diverse practice settings (20% academic, 72% private practice) and volume (≤50 new breast cancer patients, 36%; 51-100, 26%; 101-200, 25%; >200, 13%). Also, 41% of surgeons indicated routine MRI use for newly diagnosed patients, with higher rates of use among surgeons from high-volume practices, high specialization, and private practice. Greater consensus in routine MRI use was seen in the setting of extreme mammographic density (87.9%), strong family history of breast cancer (73.4%), and invasive lobular carcinoma (69.4%). Responses were increasingly discordant in setting of pursuing breast conservation (47.4%), invasive ductal carcinoma (41.8%), and ductal carcinoma in situ (37.2%). Personal experience was the most commonly cited influence on MRI use. Divergent responses in MRI use in newly diagnosed breast cancer reflect clinical uncertainty and variable practice beliefs among breast surgeons. Such diverging practice patterns highlight areas where clinical research and guidelines may be most helpful.