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Grant Details

Grant Number: 5R01CA149365-05 Interpret this number
Primary Investigator: Onega, Tracy
Organization: Dartmouth College
Project Title: Effectiveness of Pre-Operative Mri in Breast Cancer Surgery and Outcomes
Fiscal Year: 2015


DESCRIPTION (provided by applicant): Breast magnetic resonance imaging (MRI) has been used for preoperative evaluation in women with breast cancer for almost two decades, but is still the subject of clinical controversy. While preoperative breast MRI is known to detect additional cancer, the impact of this on preoperative work-up, surgical treatment and outcomes is not clear. A major question is whether detecting additional cancer leads to more aggressive work-up and surgery (mastectomy instead of breast conserving surgery) without any concomitant benefits. Prior studies have not compared population-based use of breast MRI with standard imaging modalities in relation to breast cancer surgery and important outcomes, such as re-excision, subsequent tumors, and mortality. Expanding use of breast MRI necessitates a large-scale assessment of these outcomes to inform clinical practice guidelines and to understand potential benefits and harms for women with breast cancer. This proposed research will: 1) examine the influence of preoperative breast MRI on additional cancer detection, preoperative work-ups and the relation with mastectomy vs. breast conserving surgery; 2) compare breast MRI with mammography 1 ultrasound in relation to re-excision, subsequent tumor events, and mortality; 3) assess utilization of preoperative breast MRI nationally and in subgroups of women, such as those with increased breast cancer risk; 4) estimate population-wide impacts of preoperative breast MRI use through Markov models of utilization and outcomes. We will use newly established linkages of the national Breast Cancer Surveillance Consortium (BCSC) registry data with Medicare and Group Health claims data to address these aims in a unique and novel way. These data will leverage existing resources by augmenting health care utilization data with risk factor, co morbidity, clinical assessment, and pathology information. The BCSC data consists of a large population of women primarily from community settings, enabling us to examine subgroups of women, such as those with ductal carcinoma in situ, dense breasts or family history of breast cancer, and to have greater generalizability than previous studies. Our overall objective is to provide critical evidence about the effectiveness of preoperative breast MRI compared to standard imaging modalities to inform current practice protocols, women's decision-making and health care policies. In this era of new technologies and health care reform, identifying if and when advanced modalities benefit patients is of the utmost importance to both patients and resource allocation efforts.


Breast biopsy patterns and findings among older women undergoing screening mammography: The role of age and comorbidity.
Authors: Advani S. , Abraham L. , Buist D.S.M. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. , Onega T. , Schousboe J.T. , Demb J. , et al. .
Source: Journal of geriatric oncology, 2022 Mar; 13(2), p. 161-169.
EPub date: 2021-12-09.
PMID: 34896059
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Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis.
Authors: Schousboe J.T. , Sprague B.L. , Abraham L. , O'Meara E.S. , Onega T. , Advani S. , Henderson L.M. , Wernli K.J. , Zhang D. , Miglioretti D.L. , et al. .
Source: Annals of internal medicine, 2022 Jan; 175(1), p. 11-19.
EPub date: 2021-11-23.
PMID: 34807717
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Mammography adherence in relation to function-related indicators in older women.
Authors: Zhang D. , Abraham L. , Sprague B.L. , Onega T. , Advani S. , Demb J. , Miglioretti D.L. , Henderson L.M. , Wernli K.J. , Walter L.C. , et al. .
Source: Preventive medicine, 2022 Jan; 154, p. 106869.
EPub date: 2021-11-09.
PMID: 34762965
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Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort.
Authors: Zhang D. , Abraham L. , Demb J. , Miglioretti D.L. , Advani S. , Sprague B.L. , Henderson L.M. , Onega T. , Wernli K.J. , Walter L.C. , et al. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2021 Aug; 30(8), p. 1582-1590.
EPub date: 2021-06-02.
PMID: 34078641
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Screening Mammography Outcomes: Risk of Breast Cancer and Mortality by Comorbidity Score and Age.
Authors: Demb J. , Abraham L. , Miglioretti D.L. , Sprague B.L. , O'Meara E.S. , Advani S. , Henderson L.M. , Onega T. , Buist D.S.M. , Schousboe J.T. , et al. .
Source: Journal of the National Cancer Institute, 2020-06-01; 112(6), p. 599-606.
PMID: 31593591
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Preoperative breast MRI and mortality in older women with breast cancer.
Authors: Onega T. , Zhu W. , Weiss J.E. , Goodrich M. , Tosteson A.N.A. , DeMartini W. , Virnig B.A. , Henderson L.M. , Buist D.S.M. , Wernli K.J. , et al. .
Source: Breast cancer research and treatment, 2018 Jul; 170(1), p. 149-157.
EPub date: 2018-03-07.
PMID: 29516372
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Personal history of proliferative breast disease with atypia and risk of multifocal breast cancer.
Authors: Nutter E.L. , Weiss J.E. , Marotti J.D. , Barth R.J. , Eliassen M.S. , Goodrich M.E. , Petersen C.L. , Onega T. .
Source: Cancer, 2018-04-01; 124(7), p. 1350-1357.
EPub date: 2017-12-20.
PMID: 29266172
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An Electronic Health Record-based Algorithm to Ascertain the Date of Second Breast Cancer Events.
Authors: Chubak J. , Onega T. , Zhu W. , Buist D.S.M. , Hubbard R.A. .
Source: Medical care, 2017 Dec; 55(12), p. e81-e87.
PMID: 29135770
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Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer.
Authors: Onega T. , Weiss J.E. , Goodrich M.E. , Zhu W. , DeMartini W.B. , Kerlikowske K. , Ozanne E. , Tosteson A.N.A. , Henderson L.M. , Buist D.S.M. , et al. .
Source: Journal of surgical oncology, 2017 Dec; 116(8), p. 1008-1015.
EPub date: 2017-11-11.
PMID: 29127715
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Differential Use of Screening Mammography in Older Women Initiating Metformin versus Sulfonylurea.
Authors: Hong J.L. , Henderson L.M. , Jonsson Funk M. , Lund J.L. , Buse J.B. , Pate V. , Stürmer T. .
Source: Pharmacoepidemiology and drug safety, 2017 Jun; 26(6), p. 666-675.
EPub date: 2017-03-29.
PMID: 28370798
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Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging.
Authors: Ozanne E.M. , Weiss J.E. , Onega T. , DeMartini W. , Kerlikowske K. , Buist D.S. , Henderson L. , Hubbard R.A. , Goodrich M. , Tosteson A.N. , et al. .
Source: American journal of surgery, 2017 Jan; 213(1), p. 132-139.e2.
EPub date: 2016-06-12.
PMID: 27421187
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The Role of Preoperative Magnetic Resonance Imaging in the Assessment and Surgical Treatment of Interval and Screen-Detected Breast Cancer in Older Women.
Authors: Goodrich M.E. , Weiss J. , Onega T. , Balch S.L. , Buist D.S. , Kerlikowske K. , Henderson L.M. , Hubbard R.A. , Breast Cancer Surveillance Consortium .
Source: The breast journal, 2016 Nov; 22(6), p. 616-622.
EPub date: 2016-08-23.
PMID: 27550072
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Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer.
Authors: Onega T. , Weiss J.E. , Buist D.S. , Tosteson A.N. , Henderson L.M. , Kerlikowske K. , Goodrich M.E. , O'Donoghue C. , Wernli K.J. , DeMartini W.B. , et al. .
Source: Medical care, 2016 Jul; 54(7), p. 719-24.
PMID: 27111752
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Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis.
Authors: Onega T. , Tosteson A.N. , Weiss J. , Alford-Teaster J. , Hubbard R.A. , Henderson L.M. , Kerlikowske K. , Goodrich M.E. , O'Donoghue C. , Wernli K.J. , et al. .
Source: BMC health services research, 2016-02-27; 16, p. 76.
EPub date: 2016-02-27.
PMID: 26920552
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Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities.
Authors: Alford-Teaster J. , Lange J.M. , Hubbard R.A. , Lee C.I. , Haas J.S. , Shi X. , Carlos H.A. , Henderson L. , Hill D. , Tosteson A.N. , et al. .
Source: International journal of health geographics, 2016-02-18; 15, p. 8.
EPub date: 2016-02-18.
PMID: 26892310
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Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer.
Authors: Henderson L.M. , Weiss J. , Hubbard R.A. , O'Donoghue C. , DeMartini W.B. , Buist D.S. , Kerlikowske K. , Goodrich M. , Virnig B. , Tosteson A.N. , et al. .
Source: The breast journal, 2016 Jan-Feb; 22(1), p. 24-34.
EPub date: 2015-10-28.
PMID: 26511204
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Geographic access to breast imaging for US women.
Authors: Onega T. , Hubbard R. , Hill D. , Lee C.I. , Haas J.S. , Carlos H.A. , Alford-Teaster J. , Bogart A. , DeMartini W.B. , Kerlikowske K. , et al. .
Source: Journal of the American College of Radiology : JACR, 2014 Sep; 11(9), p. 874-82.
EPub date: 2014-06-02.
PMID: 24889479
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The influence of race/ethnicity and place of service on breast reconstruction for Medicare beneficiaries with mastectomy.
Authors: Onega T. , Weiss J. , Kerlikowske K. , Wernli K. , Buist D.S. , Henderson L.M. , Goodrich M. , Alford-Teaster J. , Virnig B. , Tosteson A.N. , et al. .
Source: SpringerPlus, 2014; 3, p. 416.
EPub date: 2014-08-08.
PMID: 25140292
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