Article review of MRI utilization in Newly diagnosed Breast cancer: a survey of practicing surgeons
In this article, Parker, Schroen and Brenin present the findings of a study they conducted on breast surgeons to determine the practice beliefs which surround the use of MRI in newly diagnosed breast cancer. They state that even though there are guidelines which support the use of MRI in high risk screening, there no guidelines to facilitate the use of MRI in newly diagnosed cancer. They state that breast MRI can identify a disease which is not seen under normal diagnosis procedures such as mammography, frequently leading to a change in surgical therapy. Accordingly, the optimal utility for breast MRI in a group of over 230,000 women annually who get new diagnosis, lingers on defined. A survey was sent to 2,274 members of the American Society of Breast Surgeons over the year 2010, querying the regular use of MRI. They seek to establish the predominant clinical beliefs which exist amongst surgeons who actively treat the breast cancer patients. They state that the characterization of the real practice enables the identification of the extents of utmost clinical uncertainty, thus assisting in focusing on imminent clinical research activities and immediate development of consensus guidelines.
They analyze the responses basing on the practice setting, practice volume and the area of specialization. The responses which were significant for analysis were slightly less than 50%, from 1,012 surgeons. These response represented diverse areas of specialization, with a majority being private practice and a minority being academic practice. The volume also indicated some variations, with the highest practice volume lingering on 13 % as compared to the high scoring, low practice volume of less than 50 new breast cancer patients. They also found that 41 % of the breast cancer surgeons point out regular use of MRI for newly diagnosed breast cancer patients, with the highest use being with the surgeons with high practice volumes, private practice and highly specialized. Finally, the responses were increasingly discordant in the context of seeking breast conservation with 47.8 % while invasive ductal carcinoma was 41.8% and ductal carcinoma in situ at 37.2%. Generally, personal experience was cited as the most influential aspect of the use of MRI on new-patient breast cancer diagnosis.
These variations in responses in the use of MRI on newly diagnosed breast cancer indicate some clinical uncertainty and diverse beliefs of practice amongst the breast cancer surgeons. This pattern of variations pin point the areas where clinical guidelines and research may be significant. Thus study does not allow for the definition of the reason for the variation patterns in the use of MRI as observed in the context of practice, however may indicate higher complexity case mix across specialized practices, better access to breast MRI proficiency, apparent medicolegal issues or influence of radiology recommendations. Additionally the study indicates that the variation in the use of MRI was largely dependent on the geographical areas as well as the socioeconomic and demographic characteristics of the patient. Although the study fails to validate some specific clinical practices, it indicates some clinical uncertainty which accompanies the adoption of new medical technologies before data which defines the clinical indications of the new technology is obtained. Lastly this study presents a cross examination of the utilization of MRI in diagnosing breast cancer, reflecting a forthcoming increase in its application.
Parker, A., Schroen, A. & Brenin, D. (2013). MRI utilization in Newly diagnosed Breast cancer: a survey of practicing surgeons. Ann Surg Oncol, 20, 2600-2606.