TY - JOUR
T1 - Preoperative MRI in breast cancer
T2 - effect of breast density on biopsy rate and yield
AU - Onega, Tracy
AU - Zhu, Weiwei
AU - Kerlikowske, Karla
AU - Miglioretti, Diana L.
AU - Lee, Christoph I.
AU - Henderson, Louise M.
AU - Tosteson, Anna N.A.
AU - Wernli, Karen J.
AU - diFlorio, Roberta
AU - Weaver, Donald L.
AU - Buist, Diana S.M.
N1 - Funding Information:
Research reported in this work was funded through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (PCS-1504-30370). Data collection for this research was additionally supported by the Breast Cancer Surveillance Consortium with funding from the National Cancer Institute (P01CA154292, U54CA163303, R01CA149365) and the Agency for Health Research and Quality (R01 HS018366-01A1). The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: https://www.bcsc-research.org/about/work-acknowledgement . All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee, nor those of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. You can learn more about the BCSC at: http://www.bcsc-research.org/ . The collection of cancer incidence and vital status data used in this study was supported, in part, by: (a) The California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58-DP003862-01 awarded to the California Department of Public Health; (b) The Vermont Cancer Registry, supported in part by Cooperative Agreement NU58DP006322 from the Centers for Disease Control and Prevention, awarded to the Vermont State Agency of Human Services. (c) The Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by contracts N01-CN-005230, N01-CN-67009, N01-PC-35142, HHSN261201000029C, and HHSN261201300012I from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington; (d) The New Hampshire State Cancer Registry supported in part by cooperative agreement U55/CCU-121912 awarded to the New Hampshire Department of Health and Human Services, Division of Public Health Services, Bureau of Disease Control and Health Statistics, Health Statistics and Data Management Section; (e) The North Carolina Central Cancer Registry, which is partially supported by the Centers for Disease Control and Prevention under cooperative agreement DP12-120503CONT14; (f) Manuscripts including data from the Metro Chicago Breast Cancer Registry were supported in part by the Illinois Department of Public Health, Illinois State Cancer Registry which is partially supported by the Centers for Disease Control and Prevention under cooperative agreement DP12-120504CONT15. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, the California Department of Public Health; Illinois Department of Public Health; New Hampshire Department of Health and Human Services; the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021
Y1 - 2021
N2 - Purpose: Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well-documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density. Methods: We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005 to 2017. We quantified breast biopsies and cancers detected within 6 months of diagnosis by preoperative breast MRI receipt, overall and by breast density, accounting for MRI selection bias using inverse probability weighted logistic regression. Results: Among 19,324 women with newly diagnosed breast cancer, 28% had preoperative MRI, 11% additional biopsy, and 5% additional cancer detected. Four times as many women with preoperative MRI underwent additional biopsy compared to women without MRI (22.6% v. 5.1%). Additional biopsy rates with preoperative MRI increased with increasing breast density (27.4% for extremely dense compared to 16.2% for almost entirely fatty breasts). Rates of additional cancer detection were almost four times higher for women with v. without MRI (9.9% v. 2.6%). Conditional on additional biopsy, age-adjusted rates of additional cancer detection were lowest among women with extremely dense breasts, regardless of imaging modality (with MRI: 35.0%; 95% CI 27.0–43.0%; without MRI: 45.1%; 95% CI 32.6–57.5%). Conclusion: For women with dense breasts, preoperative MRI was associated with much higher biopsy rates, without concomitant higher cancer detection. Preoperative MRI may be considered for some women, but selecting women based on breast density is not supported by evidence. Trial registration: ClinicalTrials.gov: NCT02980848; registered 2017.
AB - Purpose: Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well-documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density. Methods: We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005 to 2017. We quantified breast biopsies and cancers detected within 6 months of diagnosis by preoperative breast MRI receipt, overall and by breast density, accounting for MRI selection bias using inverse probability weighted logistic regression. Results: Among 19,324 women with newly diagnosed breast cancer, 28% had preoperative MRI, 11% additional biopsy, and 5% additional cancer detected. Four times as many women with preoperative MRI underwent additional biopsy compared to women without MRI (22.6% v. 5.1%). Additional biopsy rates with preoperative MRI increased with increasing breast density (27.4% for extremely dense compared to 16.2% for almost entirely fatty breasts). Rates of additional cancer detection were almost four times higher for women with v. without MRI (9.9% v. 2.6%). Conditional on additional biopsy, age-adjusted rates of additional cancer detection were lowest among women with extremely dense breasts, regardless of imaging modality (with MRI: 35.0%; 95% CI 27.0–43.0%; without MRI: 45.1%; 95% CI 32.6–57.5%). Conclusion: For women with dense breasts, preoperative MRI was associated with much higher biopsy rates, without concomitant higher cancer detection. Preoperative MRI may be considered for some women, but selecting women based on breast density is not supported by evidence. Trial registration: ClinicalTrials.gov: NCT02980848; registered 2017.
KW - Breast biopsy
KW - Breast Cancer Surveillance Consortium
KW - Breast density
KW - Cancer detection rate
KW - Occult cancer
KW - Preoperative MRI
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U2 - 10.1007/s10549-021-06418-x
DO - 10.1007/s10549-021-06418-x
M3 - Article
C2 - 34686934
AN - SCOPUS:85117614513
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
SN - 0167-6806
ER -