Regional-Level Correlation of Inappropriate Prostate Imaging and Inappropriate Breast Imaging
In a study reported in JAMA Oncology, Makarov et al found that hospital referral regions marked by higher rates of inappropriate imaging in patients with low-risk breast cancer also had high rates of inappropriate prostate imaging in patients with low-risk prostate cancer. Inappropriate imaging rates were high overall.
Study Details
This retrospective cohort study used the Surveillance, Epidemiology, and End Results–Medicare linked database to identify patients diagnosed from 2004 to 2007 with low-risk prostate cancer (clinical stage T1c/T2a, Gleason score ≤ 6, and prostate-specific antigen level < 10 ng/mL) or low-risk breast cancer (in situ, stage I, or stage II). A total of 9,219 men with prostate cancer and 30,398 women with breast cancer residing in 84 hospital referral regions were included in the analysis.
Correlation of Inappropriate Imaging Rates
Overall, rates of inappropriate imaging were 44.4% for prostate cancer and 41.8% for breast cancer. In hospital referral regions in the first (lowest), second, third, and fourth quartiles of breast cancer imaging rate, inappropriate prostate cancer imaging rates were 34.2%, 44.6%, 41.1%, and 56.4%, respectively. In the first, second, third, and fourth quartiles of prostate cancer imaging rate, inappropriate breast cancer imaging rates were 38.1%, 38.4%, 43.8%, and 45.7%, respectively. At the hospital referral region level, inappropriate prostate cancer imaging rate was associated with inappropriate breast cancer imaging rate (ρ = 0.35, P < .01).
Patient Level Analysis
At the patient level, a man with low-risk prostate cancer underwent inappropriate imaging 56%, 41%, 45%, or 34% of the time if he lived in the fourth, third, second, or first hospital referral region quartiles of inappropriate breast imaging; compared with men in hospital referral regions in the lowest quartile of inappropriate breast imaging, odds ratios for inappropriate prostate imaging were 1.72 (95% confidence interval [CI] = 1.12–2.65), 1.19 (95% CI = 0.78–1.81), and 1.76 (95% CI = 1.15–2.70) for those in the fourth, third, or second quartiles (P = .02 for trend).
At the patient level, odds ratios for inappropriate breast imaging were nonsignificantly greater for women living in the fourth (1.17, 95% CI = 0.89–1.54), third (1.28, 95% CI = 0.98–1.68), or second (1.06, 95% CI = 0.81–1.38) hospital referral region quartiles for inappropriate prostate imaging (P = .27 for trend).
The investigators concluded: “At a regional level, there is an association between inappropriate prostate and breast cancer imaging rates. This finding suggests the existence of a regional-level propensity for inappropriate imaging utilization, which may be considered by policymakers seeking to improve quality of care and reduce health care spending in high-utilization areas.”
Danil V. Makarov, MD, MHS, of New York University School of Medicine, is the corresponding author for the JAMA Oncology article.
The study was supported by the Robert Wood Johnson Foundation, The Louis Feil Charitable Lead Trust, and U.S. Department of Veterans Affairs.
For full disclosures of the study authors, visit oncology.jamanetwork.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
