Trends of MRI use to Evaluate Breast Cancer in the Texas Medicare Population
Journal of Cancer Prevention & Current Research
The availability of Magnetic Resonance Imaging (MRI) has increased in the United States over the last decade. The use of MRI to diagnose and stage breast cancer has not been described. We examined the trends and frequency of MRI use in women with newly diagnosed breast cancer in Texas and evaluated the factors associated with receipt of an MRI. Methods: Medicare-linked data from the Texas Cancer Registry (TCR) were used to identify incident breast cancer cases between Jan. 1, 2003 and Dec. 30,
... 2003 and Dec. 30, 2007. We included female patients, 65 years 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 that period. Patients diagnosed at autopsy were excluded. Bivariate and multivariate logistic regression analyses were performed to determine the factors associated with receipt of MRI within 3 months before and after diagnosis. A Cochran-Armitage trend test was performed to examine the trends in use of MRI by year. A value of P<0.05 was considered statistically significant. Results: Of the 18,856 patients meeting inclusion criteria, 1,268 (6.72%) received an MRI. The use of MRI increased significantly in Texas from 2.25% of women diagnosed in 2003 to 13.9% in 2007 (P<0.0001). Bivariate analysis revealed that age, race, number of comorbidities, income, education, and urban/ rural location were associated with the receipt of MRI at the time of breast cancer diagnosis. In multivariate analysis, odds of receiving an MRI were lower in women of advanced age (odds ratio [OR] 0.098; 95% Confidence Interval [CI] 0.044-0.223), black race (OR 0.66; 95% CI: 0.49-0.88) and the presence of two or more comorbid conditions (OR 0.30; 95% CI;. Those with regional disease and a higher level of education were more likely to receive MRI. Conclusion: Use of MRI in patients with newly diagnosed breast cancer in Texas increased six-fold during the study period, but increases varied across racial groups. patients with newly diagnosed breast cancer in the Texas Medicare population and to evaluate the clinical and socioeconomic factors associated with diagnostic (not screening) MRI usage.