Abstract P1-09-03: The use of MRI in the evaluation of breast cancer
Authors: Washington TM , Sharma G , Zhang W , Cooksley C 
Published: August 2014

Abstract
Background: The availability of Magnet Resonance Imaging (MRI) has increased in the United States over the last decade. Its use for the diagnosis and staging of breast cancer remains undetermined. We examined the trends and frequency of MRI use in women with newly diagnosed breast cancer in Texas and evaluated the factors associated with a receipt of an MRI.
Methods: The Texas Cancer Registry (TCR) Medicare linked data were used to identify incident breast cancer cases between 1/1/2003-12/30/2007. We included female patients, 65 and older enrolled in both Medicare Parts A and B for 3 months prior to diagnosis and 12 months after diagnosis, and not enrolled in an HMO plan during the same period. Patients diagnosed at autopsy were excluded. Bivariate and multivariate logistic regression analysis was performed to determine the factors associated with receipt of MRI. A Cochran-Armitage trend test was performed to examine the trends in use of MRI over study period. A p-value &lt;0.05 was considered statistically significant.
Results: Of the 292,297 patients diagnosed with breast cancer between 2003 and 2007, 18, 856 patients met the inclusion criteria. Of these, 1268 (6.72%) received an MRI. The overall use of breast MRI has increased significantly in Texas from 2.25% of women diagnosed in 2003 to 13.9% of women diagnosed in 2007 (p&lt;0.001). In the bivariate analysis we found that age, race, number of comorbidities, poverty level, education level, and region were associated with the receipt of MRI at the time of breast cancer diagnosis. In the multivariate analysis after adjusting for those covariates, we found that women of advancing age, black race (34%) and presence of any comorbidity (29%) to be significantly less likely to get an MRI, while those with regional disease and higher level of education were more likely to receive MRI (table 1).
Conclusion: Breast MRI in newly diagnosed breast cancer in the state of Texas increased six fold during the study period. While use has increased in Texas, receipt of MRI does not appear to be uniform. To identify the group of women who would benefit most from MRI, more in depth analyses of the role of socio-economic components on receipt of MRI and patient outcomes is needed.
Multivariate analysis: Odds of receiving an MRI at the time of breast cancer diagnosisVariableOdds of MRI (95% CI)P-valueAge Group &lt;.000165-691 70-740.784 (0.672-0.913) 75-790.518 (0.433-0.620) 80-840.415 (0.335-0.514) 85-890.215 (0.145-0.319) &gt;900.098 (0.044-0.223) Race 0.0463White1 Black0.658 (0.492-0.880) Hispanic0.967 (0.587-1.592) Others0.931 (0.545-1.592) Comorbidity &lt;.000101 10.713 (0.607-0.839) 20.712 (0.545-0.931) &gt;20.304 (0.192-0.479) Education Level 0.00011st Quartile (highest)1 2nd Quartile0.743 (0.617-0.896) 3rd Quartile0.594 (0.464-0.760) 4th Quartile (lowest)0.544 (0.404-0.733) Urban/Rural &lt;.0001Big Metro1 Metro0.467 (0.389-0.560) Urban0.558 (0.405-0.768) Less Urban0.882 (0.706-1.101) Rural1.022 (0.642-1.628) Stage 0.01710/In situ1 Localized1.135 (0.932-1.381) Regional1.334 (1.067-1.667) Distant1.166 (0.775-1.755) Unknown0.663 (0.414-1.063)
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-03.