05:36am Monday 24 February 2020

Breast MRI may lead to overdiagnosis for older women

By Karen N. Peart
(Illustration by Patrick Lynch / Yale University)

Magnetic resonance imaging (MRI) of the breast has become part of routine medical care for many women undergoing breast cancer surgery, but these highly sensitive tests might identify health problems that would not otherwise impact patients — or lead to “overdiagnosis,” according to a Yale School of Medicine study.

Published in the Journal of Clinical Oncology, the study examined whether preoperative MRI use would allow doctors to identify breast cancer in the opposite breast (the one not affected by the diagnosed cancer) earlier, and therefore reduce the likelihood of advanced diseases in the future.

The researchers found that that nearly half of additional breast cancers detected by the preoperative MRI were overdiagnosed, which means that many of the cancers not detected by MRI would not have become clinically evident over the subsequent five years.

“This overdiagnosis is associated with false positive findings, psychological stress, more cancer detection, and costs, but does not prevent advanced disease or improve health outcomes,” said lead author Dr. Shiyi Wang, assistant professor of chronic disease epidemiology at Yale School of Public Health and a faculty member in the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale School of Medicine and Yale Cancer Center.

Wang and his colleagues analyzed the Surveillance, Epidemiology, and End Results-Medicare dataset. The team compared two groups of women who had breast cancer in terms of the occurrence of breast cancer in the opposite breast (i.e., contralateral breast cancer): One group had received an MRI, and another group did not.

The team found that after five years, the MRI group had a higher incidence of cancer in the opposite breast than the non-MRI group (7.2% vs. 4.0%). “Specifically, MRI use would approximately double the detection rate of early-stage contralateral breast cancer, but would not decrease advanced-stage contralateral breast cancer occurrences after a five-year follow-up,” said Wang. “There was no evidence that MRI use was benefiting women because the rate of advanced cancer, whose prognosis is harmful, was similar in the MRI and the non-MRI groups.”

Dr. Cary Gross, senior author of the study and professor of internal medicine at Yale School of Medicine, said, “Patients and physicians need to carefully balance risks and benefits of preoperative MRI. Preoperative breast MRI was associated with a large increase of detection rate of early-stage contralateral breast cancers, which led to additional treatments of the opposite breast.”

“This early detection by MRI use and the associated treatments would increase women’s suffering and stress, but did not prevent advance diseases or improve health outcomes,” added Gross, who is a member of Yale Cancer Center.

Other authors on the study include Jessica Long, Brigid Killelea, Suzanne Evans, Kenneth Roberts, and Andrea Silber.

This study was supported by a pilot grant and the P30 Cancer Center Support Grant (CCSG) at Yale Cancer Center.
The findings raise questions about how to prevent or reduce these conditions among the high-risk population.

Cerebral palsy is a pediatric neurodevelopmental disorder caused by damage to the brain, generally before birth. It results in a wide range of physical and developmental problems such as uncontrollable movements or muscular activity, loss of muscle tone and strength, and weakened reflexes and balance, in addition to a wide-range of medical and cognitive difficulties such as swallowing, seizures, and orthopedic abnormalities.

“As a father of a child with cerebral palsy, I’m dedicated to improving the scientific evidence and clinical care of this growing population,” says lead author Mark Peterson, Ph.D., M.S., assistant professor of physical medicine and rehabilitation at the University of Michigan.
Lead author
Mark Peterson, Ph.D., M.S.

“Unfortunately, it’s still not fully understood how to best care for individuals with cerebral palsy as they transition into and throughout adulthood. We sought to determine whether adults with cerebral palsy suffer from secondary chronic health conditions more frequently, and how that can affect future medical care for this population,” he adds.

The new study, published Dec. 1 in JAMA, measured the prevalence estimates of eight, lifestyle-related chronic health conditions in both adults with cerebral palsy and those without.

The research team used data from the Medical Expenditure Panel Survey, a set of large-scale surveys conducted by the Agency for Healthcare Research and Quality to find and collect data on health care services, usage and costs. The study included 207,615 adults, ages 18 or older, with 1,015 of those having cerebral palsy.

The team determined adults with cerebral palsy were between two and five times more likely to have these chronic health conditions than adults without cerebral palsy. After adjusting for age, numerous sociodemographic factors, body mass index, physical activity, and degree of disability, they still found the prevalence of chronic health conditions significantly greater in adults with cerebral palsy.

Specifically, they found:

    Diabetes, 9.2 percent in adults with cerebral palsy versus 6.3 percent in adults without
    Asthma, 20.7 percent vs. 9.4 percent
    Hypertension, 30 percent vs. 22.1 percent
    Other cardiovascular conditions, 15.1 percent vs.9.1 percent
    Stroke, 4.6 percent vs. 2.3 percent
    Emphysema, 3.8 percent vs. 1.4 percent
    Joint pain, 43.6 percent vs. 28 percent
    Arthritis, 31.4 percent vs. 17.4 percent

They also found age, sex, obesity, degree of physical disability and physical inactivity to be significantly associated with each of the chronic conditions.

Peterson says the results indicate chronic health conditions are much more common in adults with cerebral palsy and should raise questions among fellow health care providers.

“Because cerebral palsy results in accelerated losses of mobility with age, individuals tend to experience more fatigue and have greater muscle and joint pain over time. We found physical inactivity and immobility were strongly associated with these chronic health conditions,” Peterson says.

“Therefore, we need to strongly consider how these health complications could further impact this population, and how we can prevent or reduce these conditions among individuals with cerebral palsy through their lifespan.”

Authors: In addition to Peterson, the study’s authors include Edward Hurvitz, M.D., chair of the U-M Department of Physical Medicine and Rehabilitation, Elham Mahmoudi, Ph.D., of the U-M Department of Surgery, and Jennifer Ryan, Ph.D., of the Institute of Environment, Health and Societies at Brunel University London.

Funding: Funding for the study came from the National Institutes of Health (grant 1KO1 HD074706).

Disclosures: none.

Reference: JAMA, http://dx.doi.org/10.1001/jama.2015.11025.

Media Contact: Kylie O’Brien 734 764-2220

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