Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer.

Morrow M, Hawley ST, McLeod MC, Hamilton AS, Ward KC, Katz SJ, Jagsi R. Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer. Annals of Surgical Oncology. 2017 Jul 1; 24(7):1889-1896.

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Abstract:

BACKGROUND: Usage of magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is increasing, despite scant evidence that it improves outcomes. Little is known about the knowledge, perspectives, and clinical characteristics of surgeons associated with MRI use. METHODS: Women with early-stage breast cancer undergoing definitive surgery between July 2013 and August 2015 were identified from the Los Angeles and Georgia Surveillance, Epidemiology and End Results (SEER) registries and were asked to name their attending surgeons. The 489 surgeons were sent a questionnaire; 77% (n  =  377) responded. Questions that addressed the likelihood of ordering an MRI in different scenarios were used to create a scale to measure surgeon propensity for MRI use. Knowledge and practice characteristics also were assessed. RESULTS: Mean surgeon age was 54 years, 25% were female, and median number of years in practice was 21. Wide MRI use variation was observed, with 26% obtaining MRI for a clinical stage I screen-detected breast cancer and 72% for infiltrating lobular cancer. High users of MRI were significantly more likely to be higher-volume surgeons (p  <  0.001) and to have misconceptions about MRI benefits (p  <  0.001). Of surgeons who felt they used MRI more often, 60% were high MRI users; only 6% were low MRI users. CONCLUSIONS: Our findings suggest relatively frequent use of MRI, even in uncomplicated clinical scenarios, in the absence of evidence of benefit, and use was more common among high-volume surgeons. A substantial number of surgeons who are high MRI users harbor misconceptions about MRI benefit, suggesting an opportunity for education and consensus building regarding appropriate use.