Franc BL, et al. - Researchers assessed if and to what extent US geography influences the use rates of both recommended and high-cost imaging in young patients with early-stage breast cancer during the 18-month period after surgical treatment of their primary tumor. They found that geography influenced the rates of posttreatment imaging in patients with breast cancer treated for low-risk disease. Non-receipt of beneficial dedicated breast imaging by some patients was seen, and high-cost nonbreast imaging may not be targeted to those groups most likely to benefit.

Methods

• Researchers performed this descriptive analysis, using the Truven Health MarketScan Commercial Database to determine geographic variation in annual rates of dedicated breast imaging and high-cost body imaging of 36,045 women aged 18 to 64 years treated with surgery for invasive unilateral breast cancer between 2010 and 2012.
• They carried out multivariate hierarchical analysis to assess the link between likelihood of imaging and patient characteristics, with metropolitan statistical area (MSA) serving as a random effect.
• Age group, BRCA1/2 carrier status, family history of breast cancer, combination of breast surgery type and radiation therapy, drug therapy, and payer type were included as patient characteristics.
• They included all MSAs in the US, with areas outside MSAs within a given state aggregated into a single area for analytic purposes.

Results

• Findings revealed that, regardless of treatment cohort or age group, wide geographic variation was evident in the descriptive analysis of rates of imaging use and intensity within MSA regions.
• They found that increased probability of recommended postoperative dedicated breast imaging was mainly related to age and treatment including both surgery and radiation therapy, followed by MSA region (odds ratio, 1.42).
• They also observed that increased probability of PET use—a high-cost imaging modality for which postoperative routine use is not recommended in the absence of specific clinical findings—was primarily related to surgery type followed by MSA region (odds ratio, 1.82).