Pollack Craig E, Soulos Pamela R, Herrin Jeph, Xu Xiao, Christakis Nicholas A, Forman Howard P, Yu James B, Killelea Brigid K, Wang Shi-Yi, Gross Cary P
Johns Hopkins School of Medicine, Baltimore, MD, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Natl Cancer Inst. 2017 Aug 1;109(8). doi: 10.1093/jnci/djw330.
Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are widely used in breast cancer practice despite unproven benefits. We examined the extent to which social contagion is associated with adoption of these imaging modalities.
We used Surveillance, Epidemiology, and End Results-Medicare to construct peer groups of physicians who shared patients during a baseline period when these imaging modalities were starting to disseminate into practice (2004-2006) and determined the potential impact of these peer groups during a follow-up period (2007-2009). For non-early-adopting surgeons (whose patients did not receive MRI/PET during baseline), we used hierarchical logistic regression models to examine the effect of their peer group's baseline use on their use of MRI/PET during the follow-up period, adjusting for patient characteristics and hospital MRI/PET use.
For MRI, there were 6424 women diagnosed in the follow-up period assigned to 986 non-early-adopting surgeons. During baseline, 9.3% of women received an MRI, varying across peer groups from 0% to 81%. Women assigned to surgeons whose peers had the highest rate of baseline MRI use were more likely to receive MRI compared with women whose surgeons' peers did not use MRI (24.9% vs 10.1%, adjusted odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.39 to 4.39). Physician peers were associated with uptake of PET imaging (OR for highest vs lowest baseline peer group PET use = 2.04, 95% CI = 1.24 to 3.36).
The phenomenon of social contagion may offer opportunities to better understand how new approaches to cancer care disseminate into clinical practice.
尽管磁共振成像（MRI）和正电子发射断层扫描（PET）扫描的益处尚未得到证实，但它们在乳腺癌诊疗中被广泛应用。我们研究了社会传播与这些成像方式采用之间的关联程度。
我们利用监测、流行病学和最终结果 - 医疗保险数据构建了在这些成像方式开始应用于临床实践的基线期（2004 - 2006年）共享患者的医生同侪群体，并确定了这些同侪群体在随访期（2007 - 2009年）的潜在影响。对于非早期采用者的外科医生（其患者在基线期未接受MRI/PET检查），我们使用分层逻辑回归模型来检验其同侪群体在基线期的使用情况对他们在随访期使用MRI/PET的影响，并对患者特征和医院MRI/PET使用情况进行了调整。
对于MRI，在随访期有6424名女性被诊断患有乳腺癌，她们被分配给986名非早期采用者的外科医生。在基线期，9.3%的女性接受了MRI检查，不同同侪群体之间的比例从0%到81%不等。与外科医生同侪未使用MRI的女性相比，被分配给同侪基线期MRI使用率最高的外科医生的女性更有可能接受MRI检查（24.9%对10.1%，调整后的优势比[OR] = 2.47，95%置信区间[CI] = 1.39至4.39）。医生同侪与PET成像的采用有关（基线期同侪群体PET使用率最高与最低相比，OR = 2.04，95% CI = 1.24至3.36）。
社会传播现象可能为更好地理解癌症治疗新方法如何传播到临床实践中提供机会。
