Where You Live Affects How Inappropriately Imaging is Used

Inappropriate imaging for both low-risk prostate and low-risk breast cancers were frequently performed before the initiation of the Choosing Wisely campaign, according to a study published in JAMA Oncology.

Researchers from the University School of Medicine in New York, NY, performed a retrospective cohort study to determine whether regional rates were associated with inappropriate prostate cancer and breast cancer imaging.

The study comprised 9,219 men with prostate cancer and 30,398 women with breast cancer living in 84 hospital referral regions (HRRs). The patients were diagnosed from 2004 to 2007, based on Choosing Wisely definitions.

The dependent variable was the HRR-level imaging rate among patients with low-risk prostate cancer. The independent variable was HRR-level imaging rate among patients with low-risk breast cancer.

The results showed high rates of inappropriate imaging: 44.4% rate of imaging for prostate cancer and 41.8% for breast cancer.

The researchers found that inappropriate prostate cancer imaging rates were associated with inappropriate breast cancer imaging rates, according to the results. A man with low-risk prostate cancer had higher odds of undergoing inappropriate imaging if he lived in an HRR with higher inappropriate breast cancer imaging.

Inappropriate prostate cancer imaging, according to the quartiles of breast cancer imaging:

Inappropriate breast cancer imaging, according to quartiles of prostate cancer imaging:

“We observed a regional-level association in the rates of inappropriate imaging of Medicare beneficiaries with low risk prostate cancer and low-risk breast cancer,” the authors concluded. “Our findings suggest that, contrary to the position of the IOM [Institute of Medicine], regional-level factors may be important in determining utilization of health care resources.” Formal educational programs may help clinicians reduce the use of inappropriate imaging.