A large percentage of patients with stage I and II breast cancer underwent unneeded chest CT as part of the initial workup, according to results from a recent study in the Journal of the National Comprehensive Cancer Network.
Almost one-third of patients with early-stage breast cancer had pulmonary nodules, though pulmonary metastases were subsequently diagnosed in only 1.3% of these patients. This rate of CT scans at this disease stage does not align with NCCN Guidelines; adherence to the guidelines would reduce unnecessary chest CT scans.
NCCN Guidelines recommend patients with stage I and II breast cancer undergo chest CT only when symptomatic, yet many asymptomatic patients undergo chest CT.
This study identified from a prospectively maintained database patients with breast cancer diagnosed between 1998 and 2012. Researchers included patients with stage I/II disease who did not undergo neoadjuvant chemotherapy.
In total, 3321 patients had early-stage breast cancer; 62.1% (n=2062) had stage I disease, and 37.9% (n=1259) had stage II disease. More than 10% of patients with stage I disease (n=227) and 36.2% of patients with stage II disease (n=456) underwent chest CT.
Of the patients who underwent CT, 26.9% (n=184) had pulmonary nodules that were 5 mm or smaller (69.6% of patients), 5-10 mm (25.0%), 11-20 mm (3.2%), and 20 mm or larger (2.2% of patients).
Only 9 patients (1.3%) who underwent CT for staging eventually received a diagnosis of pulmonary metastases, at an average of 25 months after initial CT.
1. Dull B, Linkugel A, Margenthaler JA, Cyr AE. Overuse of chest CT in patients with stage I and II breast cancer: an opportunity to increase guidelines compliance at an NCCN member institution. J Natl Compr Canc Netw. 2017;15(6):783-789.