Research seems to gang up on the modality, but take a pause

Dan Anderson

MRI has been thrashed about quite a bit in the last couple of months.

A study from the Mayo Clinic found that within their facility, a growing number of women opted for mastectomy rather than a lumpectomy. In data presented at the American Society of Clinical Oncology meeting last month, physicians at Mayo tracked more than 5,000 surgery patients from 1997 to 2006. The percentage of patients who opted for mastectomy was nearly identical in 1997 and 2006—44% and 43%, respectively—but was as low as 30% in 2003. More than half of the mastectomy patients had an MRI before making their decision. Just 41% who had not undergone MRI opted for total breast removal.

The good news is that these patients using MRI were able to rely on a modality that can detect much smaller tumors much earlier. But MRI also can present false positives, which could lead some women to choose an unnecessary mastectomy.

"What we don't know from this study is whether the higher rate of mastectomy observed in our patients undergoing MRI is related to the detection of additional disease, or whether the uncertainty raised by MRI leads to greater anxiety for the patient and physician, thus leading patients and physicians to choose mastectomy over lumpectomy," said Matthew Goetz, MD, assistant professor of oncology at Mayo, and principal author of the study.

Then comes the study from the IMV group, a market research company that specializes in medical imaging markets. Its census of MRI sites in the United States showed an annualized 3% increase. Why is that bad news? Well, from 1999 to 2003, the annual growth was 15%.

Ouch.

One reason for part of that slowdown may simply be that the marketplace is saturated. Nearly 7,200 sites performed 27.5 million procedures last year. But IMV notes a couple of specific areas in which the Deficit Reduction Act has shown its ugly head. With reimbursements down, so too are orders for MRIs. Large facilities are making do with one piece of equipment instead of two or more. But the news that struck me the most is that imaging suites are waiting longer to replace their MRIs.

All of the vendors offer service for their machines, so I'm not suggesting that there's an inherent risk to patients with this trend. But imaging is an area that is rapidly changing; if hospitals and imaging centers are taking longer to install newer equipment, patients are missing out on some of the benefits these newer offerings, such as 3T, provide.

What's called for in each of these studies is prudence. Let's find out what's behind the number of mastectomies at Mayo. Are similar results found at other hospitals? Do the results of an MRI truly affect a patient's decision? How about other areas of care: If an MRI can help treatment earlier or better, why not use it? And since there seems to be no end in sight to the government's giveth-and-taketh-away approach to medical reimbursements, why let that stall purchasing new or updated equipment?

All that's at stake here is people's lives.

Dan Anderson
Editorial Director