Growing use of magnetic resonance imaging (MRI) is leading to unnecessary breast removal in many older women with breast cancer, according to a study by Yale School of Medicine researchers.
The study, published in the journal Breast Cancer Research and Treatment, is based on analysis of the use of breast MRI and surgical care of 72,461 female Medicare patients — aged 67-94 — who were diagnosed with breast cancer from 2000 to 2009.
The team found a huge rise the use of preoperative breast MRI over the study period — from 1 percent in 2000-2001 to 25 percent in 2008-2009. The researchers also found women who received an MRI were more likely to undergo more aggressive surgical treatment and have bilateral mastectomy — surgery to remove both breasts — when cancer was found in only one breast.
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Among women who underwent mastectomy, 6.9 percent who had an MRI had both breasts removed, compared to 1.8 percent of those who did not have an MRI.
"These data are concerning because the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear," said lead researcher Cary Gross. M.D., associate professor of internal medicine at Yale School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research 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," Dr. Gross added.
Co-researcher Brigid Killelea, M.D., assistant professor of surgery at Yale School of Medicine, said more study is needed to assess the risks and benefits of MRI use in planning treatment for breast cancer.
"There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age," said Dr. Killelea. "Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer."
This study was funded, in part, by the National Cancer Institute.
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