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Women with early-stage breast cancer frequently undergo potentially unnecessary imaging
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A large number of women with early-stage breast cancer received imaging tests that may be medically unnecessary, according to retrospective study results presented at the Quality Care Symposium.
Factors underlying the use of imaging should be studied to reduce the rates of unnecessary scanning, especially among women with stage IIB disease, according to the researchers.
Practice guidelines do not recommend advanced imaging for the diagnosis of metastatic stage 0 to stage II breast cancer, according to study background.
“The chance of finding cancer that has spread to other parts of the body on a scan is only about 1% for a woman with stage I or stage II breast cancer,” Norah Lynn Henry, MD, PhD, associate professor of internal medicine at University of Michigan, said in a press release. “It is concerning that so many women are receiving tests that have little benefit to them but may lead to excessive radiation exposure, invasive procedures, anxiety and financial hardship.”
Henry and colleagues sought to examine variations in ordering CT chest, abdomen and pelvis scans, PET scans, and bone scans for women treated for early-stage breast cancer in the state of Michigan. They further investigated clinical and nonclinical factors associated with test ordering.
The researchers used the Michigan Breast Oncology Quality Initiative database to identify 27,011 women diagnosed with early-stage breast cancer in Michigan between 2008 and 2014 at 25 health centers. They used medical records to ascertain demographic information, pathologic data and imaging orders.
The percentage of patients with at least one advanced imaging test performed within 90 days of a breast cancer diagnosis served as the primary endpoint.
Overall, 17.8% (n = 4,799) of the cohort had at least one staging exam within 90 days of diagnosis. Imaging tests occurred most frequently after surgery.
Imaging rates varied by disease stage, with the most frequent imaging occurring in women with stage IIB (53%) or stage IIA (33%) disease.
The researchers also observed extreme variance in imaging by site, with hospitals imaging between 3% and 85% of women.
Testing rates decreased over time for women with stage 0, stage I and stage IIA disease. However, imaging remained high for women with stage IIB breast cancer.
In a multivariate analysis, younger age, black race, HR-negative or HER-2–positive disease, and high tumor grade appeared associated with the increased likelihood for potentially unnecessary imaging.
“The scans we have today are very sensitive, meaning they pick up many small abnormalities, most of which are never going to be clinically important,” Henry said. “However, if we find small lung or liver nodules, we often have to keep repeating the scan to make sure the nodules don’t change. At each step of the way, you are increasing anxiety for the patient — while they are waiting for the scan to be performed, waiting for the results, it snowballs.” – by Cameron Kelsall
Reference:
Henry NL, et al. Abstract 287. Presented at: Quality Care Symposium; Feb. 26-27, 2016; Phoenix.
Disclosure: Blue Cross/Blue Shield of Michigan and Blue Care Network provided funding for this study. Henry reports research funding and travel expenses from Celldex, as well as research funding from BioMarin and Sanofi. One study researcher reports research funding from and/or consultant roles with Blue Care Network, Blue Cross/Blue Shield of Michigan, and 3M.