The Challenge of Developing Quality Measures for Breast Cancer Surgery

Morrow, Monica

doi:10.1001/jama.2012.74

Cited by 36 publications

(24 citation statements)

References 19 publications

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“…Studies have found that breast MRI may be associated with more downstream imaging such as follow-up ultrasounds, more biopsies, and treatment delay [44, 49, 50]. The increased morbidity that may arise from the downstream consequences of breast MRI in absence of clear clinical benefit is troubling as more breast cancer patients are having comparatively favorable prognoses, and many clinicians are focusing on reducing treatment burden and morbidity [51]. …”

Section: Discussionmentioning

confidence: 99%

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Fortune-Greeley

Wheeler

Meyer

et al. 2013

Breast Cancer Res Treat

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Background Existing evidence suggests that preoperative breast magnetic resonance imaging (MRI) might not improve surgical outcomes in the general breast cancer population. To determine if patients differentially benefit from breast MRI, we examined surgical outcomes—initial mastectomy, reoperation, and final mastectomy rates—among patients grouped by histologic type. Methods We identified women diagnosed with early-stage breast cancer from 2004-2007 in the SEER-Medicare dataset. We classified patients as having invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), mixed ductal/lobular carcinoma (IDLC) or other histologic type. Medicare claims were used to identify breast MRI and definitive surgeries during the initial surgical treatment episode. We used propensity score methods to account for the differential likelihood of exposure to MRI. Results Of the 20,333 patients who met our inclusion criteria for this study, 12.2% had a preoperative breast MRI. Patients with ILC as compared to other histologic groups were most likely to receive MRI (OR: 2.32; 95% CI: [2.02, 2.67]). In the propensity score adjusted analyses, breast MRI was associated with an increased likelihood of an initial mastectomy for all patients and among all histologic subgroups. Among patients with ILC, having a breast MRI was associated with lower odds of a reoperation (OR: 0.59; 95% CI [0.40, 0.86]), and an equal likelihood of a final mastectomy compared to similar patients without a breast MRI. Overall and among patients with IDC and IDLC, breast MRI was not significantly associated with a likelihood of a reoperation but was associated with greater odds of a final mastectomy. Conclusion Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning; it does not provide evidence for the routine use of breast MRI among all newly diagnosed breast cancer patients or among patients with IDC.

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Section: Discussionmentioning

confidence: 99%

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Fortune-Greeley

Wheeler

Meyer

et al. 2013

Breast Cancer Res Treat

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“…We also propose that routine requirements for margins that are wider than negative should be abandoned by surgeons, radiation oncologists, and tumor boards. The use of reexcision rates as a quality measure, which has the potential to promote unnecessarily wide resections (in addition to many other problems), 34 should also be eliminated. We believe that the weight of evidence is sufficient to initiate these changes now.…”

Section: S O U N D I N G B O a R Dmentioning

confidence: 99%

Surgical Margins in Lumpectomy for Breast Cancer — Bigger Is Not Better

2012

Self Cite

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“…Who are the hospitals that organized health care in the most cost-effective way: the ones who performed over 70 % or those who had 'only' 10 % of preoperative MRI? [4]. The introduction of a "Pay for Performance" or "Pay for Quality" system" is not a magic bullet!…”

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confidence: 99%

Pitfalls in the Quality Management of Cancer Care

Verhoeven¹

2015

JCPCR

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There are a lot of pitfalls threatening the quality management of our patients. Conflicts of interest, overuse, underuse and misuse of diagnostic and treatment modalities can harm patients and are difficult to detect. A lot of confounding factors are present. It is very difficult to define the right standard, because it will depend on your personal point of view and the quality of the evidence based system. Quality measurements must integrate the different elements of care, looking at health care as a complex adaptive system. We must be aware of budget restrictions, bureaucracy and last but not least: The Human Factor, Fraud and Money!

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The Challenge of Developing Quality Measures for Breast Cancer Surgery

Cited by 36 publications

References 19 publications

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Surgical Margins in Lumpectomy for Breast Cancer — Bigger Is Not Better

Pitfalls in the Quality Management of Cancer Care

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