Routine Scanning in Early-Stage Breast Cancer Unnecessary, Greater Harms

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No cases of metastatic disease were detected by routine scanning, and in fact, false positive findings were identified in 43% of cases, researchers found.
No cases of metastatic disease were detected by routine scanning, and in fact, false positive findings were identified in 43% of cases, researchers found.

The American Society of Clinical Oncology (ASCO) launched the Choosing Wisely Initiative in 2012, which recommended against routine imaging in patients with early-stage breast cancer. Now, in a study presented at 2018 ASCO Quality Care Symposium, researchers at Mount Sinai Beth Israel Foundation have found additional support for that recommendation.

“Our study highlights the prevalence of unnecessary scans in up to 19% of patients with stage I-II breast cancer,” write the authors. They collected data on women with stage I-II breast cancer between January 1, 2014, and December 31, 2015, from the Cancer Registry of Mount Sinai Health System. Of the 733 identified patients with breast cancer, the median age at diagnosis was 58 with a range of 26 to 98. Approximately 19% of patients underwent routine imaging and 42% of patients underwent at least one ensuing scan in the 1-year follow-up. The most common type of scan was PET/CT, followed by CT, ordered by medical oncologists (52%) or surgical oncologists (44.6%).

No cases of metastatic disease were detected by routine scanning, and in fact, false positive findings were identified in 43% and incidental findings in 8% of cases. Altogether the cost of imaging was approximately $4480 per patient. The authors of the study contest that too much scanning might in fact be harmful. They write, “The presence of T2 tumor, positive lymph node, TN disease and young age were associated with increased staging scan. Further educational efforts are needed to avoid unnecessary scans in patients with early stage breast cancer.”

Reference

Velazquez Manana AI, Nguyen N, Rodriguez Bonilla C, Shao T. Utility and factors associated with imaging early-stage breast cancer: are we choosing wisely? Poster presentation at: 2018 ASCO Quality care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 52.

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