Utilization of Mammography Prior to Elective Breast Surgery: A National Claims-Based Analysis
Erika D. Sears, MD, MS1, Yu-Ting Lu, MPH1, Peter R. Swiatek, BA1, Ting-Ting Chung, MS2, Kevin C. Chung, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
PURPOSE:In an effort to reduce unnecessary procedures and tests, the American Society of Plastic Surgeons, as part of the Choosing Wisely Campaign in 2014, recommend against performing preoperative mammography in women undergoing elective breast surgery beyond what is recommended for the general population based on age and risk factors. This study sought to measure mammography use in patients evaluated for symptomatic macromastia, and assess the impact of preoperative mammography on future diagnostic testing and diagnoses of benign or malignant breast disease, particularly among women in low-risk age groups.
METHODS:We analyzed the Truven MarketScan Databases from 2009 - 2015 to identify female patients age 18 years and older diagnosed with macromastia. Patients were excluded if they were not observed at least 12 months before and after diagnosis of macromastia, and if they had genetic susceptibility to breast cancer, prior benign or nonspecific breast disease, or prior personal/family history of breast cancer. We identified a subgroup of patients who underwent screening and/or diagnostic mammography within 12 months of initial macromastia evaluation. We recorded additional procedures (MRI, ultrasound, and biopsy) performed within 3 months after mammography and new diagnoses of benign or malignant breast disease after mammography. For comparison rates of new diagnoses of benign or malignant breast disease, a cohort of women without macromastia from the general population 18 years and older was selected from the 2013 database. Age-specific rates of mammography use were compared between the macromastia and general population cohorts using the Chi-square test.
RESULTS:The study cohort included 52,486 female patients diagnosed with macromastia. Mammography was used in 59.6% (N=31,284) of macromastia patients. Among macromastia patients 30-39 years of age, 30.1% underwent screening and/or diagnostic mammography, compared to 5.7% of the general population (P<0.001) (Table 1). Macromastia patients 29 years and younger also had a higher rate of mammography use (4.3%) compared to general population (0.2%) (P<0.001). Of the 3,657 macromastia patients age 39 years and younger who received mammography, 16.2% (N=593) received at least one subsequent test or procedure (MRI, ultrasound, or biopsy) within the 3 months following mammography, whereas only 0.46% (N=17) were diagnosed with malignant breast disease after mammography (Table 2). A subsequent biopsy was performed in 8.3% (N=273) of macromastia patients age 39 years and younger (N=3,657) within 3 months of mammography.
CONCLUSION:This study showed that rates of additional testing and invasive procedures after mammography are not inconsequential for patients in low risk age groups in the setting of evaluation for elective breast surgery. However, the incidence of breast cancer diagnosis is very low in this study population. Providers must realize the impact of mammography use in young patients prior to elective breast surgery as it translates to a real risk of additional studies and invasive procedures.
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