Abstract
Preoperative breast magnetic resonance imaging (mri) is commonly requested by surgeons in the initial workup of women with breast cancer; however, its use is controversial. We performed a survey of breast cancer surgeons across Canada to investigate current knowledge about, attitudes to, and self-reported use of preoperative breast mri in a publicly funded health care system in light of the limited evidence to support it. All identified general surgeons in Canada were mailed a survey instrument designed to probe current practice and knowledge of published trials. Of 403 responding surgeons, 233 (58%) indicated that they performed breast cancer surgery. Of those 233, 218 (94%) had access to breast mri and completed the entire survey. Overall, 54.6% of responding surgeons felt that breast mri was useful in surgical planning, and more than half (58.3%) indicated that their frequency of use was likely to increase over the next 5 years. Surgeons found preoperative mri most useful in detecting mammographically occult disease (71.5% of respondents) and in planning for breast-conserving surgery (57.3%). The main limitations reported were timely access to mri (51%) and false positives (36.7%). Responses suggest a knowledge gap in awareness of published trials in breast mri. Our study found that, in early-stage breast cancer, self-reported use of mri by breast cancer surgeons in Canada varied widely. Reported indications did not align with published data, and significant gaps in self-reported knowledge of the data were evident. Our results would support the development and dissemination of guidelines to optimize use of mri.
Highlights
Breast cancer is the most common cancer affecting women, with more than 26,300 patients diagnosed in Canada each year[1]
Other studies evaluating the role of preoperative breast mri in women with bca have been performed and have demonstrated no statistically significant increase in mastectomy rates[10,11,12,13,14,15,16]
Self-reported use of preoperative breast mri in women with early-stage bca varied quite widely for bca surgeons in Canada, and reasons for requesting preoperative breast mri often varied from published guidelines
Summary
Breast cancer (bca) is the most common cancer affecting women, with more than 26,300 patients diagnosed in Canada each year[1]. The use of preoperative breast mri in addition to routine mammography and breast ultrasonography has become increasingly common since about 2010. Estimates of specificity for breast mri in the detection of bca in the literature have varied greatly, with different results arising because of variability in study populations, technical methods, and the criteria used for interpretation of an abnormal result[3]. Preoperative breast magnetic resonance imaging (mri) is commonly requested by surgeons in the initial workup of women with breast cancer; its use is controversial. We performed a survey of breast cancer surgeons across Canada to investigate current knowledge about, attitudes to, and self-reported use of preoperative breast mri in a publicly funded health care system in light of the limited evidence to support it
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