Perioperative magnetic resonance imaging in breast cancer care: Distinct adoption trajectories among physician patient-sharing networks
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Despite no proven benefit in clinical outcomes, perioperative magnetic resonance imaging (MRI) was rapidly adopted into breast cancer care in the 2000's, offering a prime opportunity for assessing factors influencing overutilization of unproven technology. OBJECTIVES: To examine variation among physician patient-sharing networks in their trajectory of adopting perioperative MRI for breast cancer surgery and compare the characteristics of patients, providers, and mastectomy use in physician networks that had different adoption trajectories. METHODS AND FINDINGS: Using the Surveillance, Epidemiology, and End Results-Medicare database in 2004-2009, we identified 147 physician patient-sharing networks (caring for 26,886 patients with stage I-III breast cancer). After adjusting for patient clinical risk factors, we calculated risk-adjusted rate of perioperative MRI use for each physician network in 2004-2005, 2006-2007, and 2008-2009, respectively. Based on the risk-adjusted rate, we identified three distinct trajectories of adopting perioperative MRI among physician networks: 1) low adoption (risk-adjusted rate of perioperative MRI increased from 2.8% in 2004-2005 to 14.8% in 2008-2009), 2) medium adoption (8.8% to 45.1%), and 3) high adoption (33.0% to 71.7%). Physician networks in the higher adoption trajectory tended to have a larger proportion of cancer specialists, more patients with high income, and fewer patients who were Black. After adjusting for patients' clinical risk factors, the proportion of patients undergoing mastectomy decreased from 41.1% in 2004-2005 to 38.5% in 2008-2009 among those in physician networks with low MRI adoption, but increased from 27.0% to 31.4% among those in physician networks with high MRI adoption (p = 0.03 for the interaction term between trajectory group and time). CONCLUSIONS: Physician patient-sharing networks varied in their trajectory of adopting perioperative MRI. These distinct trajectories were associated with the composition of patients and providers in the networks, and had important implications for patterns of mastectomy use.
Source: PLoS ONE
Institutions: Yale University, Johns Hopkins University, Johns Hopkins Medicine
Language: English
Topic: MRI in cancer diagnosis
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,805
Funders: U.S. Department of Housing and Urban Development, Mayo Clinic, California Department of Public Health, Yale University, Gilead Sciences, University of Southern California, Johns Hopkins University, National Comprehensive Cancer Network, National Institutes of Health, Centers for Disease Control and Prevention, Genentech, Centers for Medicare and Medicaid Services, National Cancer Institute, National Center for Advancing Translational Sciences
Awards: G1044130170, G1392909379, G148522456, G1883905839, G1932976417, G2089898225, G2348368848, G2612351997, G309361071, G3409930413, G3509688676, G4153942599, G4636760173, G529197361, G6050584259, G6718950571, G756236474, G760599220, G7767432944, G799849773, G8385479707, G9000240828, Yale Clinical and Translational Science Award
OpenAlex ID: W4220694563