Women saddled with multiple preoperative breast imaging visits

A review of Medicare data has revealed that preoperative breast-imaging claims on multiple (two or more) dates have been increasing substantially since 1992, suggesting that the patient's time burden for such evaluation has also been increasing.

“The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year,” affirmed surgical oncologist Richard J. Bleicher, MD, of the Fox Chase Cancer Center in Philadelphia, Pennsylvania, in a statement announcing the findings. “They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising.”

Bleicher presented his group's research at the CTRC-AACR San Antonio Breast Cancer Symposium, held December 6-10, 2011, in San Antonio, Texas.

Among 353,265 Medicare patients who developed breast cancer between 1992 and 2005, 67,751 women older than 65 years (median age 75 years) had invasive, nonmetastatic disease and underwent simultaneous lumpectomy or mastectomy with lymph node staging.

Average preoperative interval length (time from patient's first reported breast complaint to surgery) was 37 days. In the 6 months before that interval, mammography was performed in 34,192 (50.5%) patients, breast ultrasonography in 16,936 (25.0%) patients, and breast magnetic resonance imaging (MRI) in 180 (0.3%) patients. During the preoperative interval, mammography was performed in 30,414 (44.9%) patients, breast ultrasonography in 17,983 (26.5%) patients, and MRI in 1,409 (2.1%) patients.

During the preoperative interval, imaging was performed on two or more dates in 4.9% of patients in 1992, but that figure more than quadrupled to 19.4% by 2005. During this interval, use of more than one imaging modality on any given date increased from 4.3% in 1992 to 27.1% in 2005. MRI was performed alone 94.1% of the time; mammography alone 71.9% of the time.

The total number of imaging dates in the preoperative interval was inversely related to age.

Bleicher pointed out that the cost of imaging is rising even faster than the cost of breast cancer care, and suggested that one reason might be the frequency and amount of imaging. He also noted that reimbursement policies might influence the number of imaging appointments a person is allowed to undergo in one visit.

Bleicher and colleagues are calling for efforts to further consolidate preoperative breast-imaging visits to lower the burden among Medicare patients, whose advanced age may make multiple visits even more challenging for them.

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