Norah Lynn Henry, MD, University of Michigan (Ann Arbor, MI), presented findings to suggest that newly diagnosed patients with early-stage breast cancer often undergo advanced imaging tests despite national guidelines recommending against the practice.
In patients with stage 1 or stage 2 breast cancer, the likelihood of finding evidence of disease progression through body scans is only about 1%. Therefore, national guidelines have recommended against the use of these scans in this patient population unless individuals present with symptom or blood test abnormalities. Unneeded tests pose the risk of producing false-positive readings, which can lead to high costs, anxiety, and more unneeded procedures for patients.
In a study, Dr Henry and her colleagues examined variations in the ordering of computerized tomography (CT) scans for the chest, abdomen, and pelvis as well as positron emission tomography (PET) and bone scans across the state of Michigan to determine the reasons for why tests were being ordered.
For their study, researchers prospectively collected data from all patients diagnosed with stage 0-2 breast cancer from 2008 to 2014 at 25 health systems in the Michigan Breast Oncology Quality Initiative, a Blue Cross Blue Shield of Michigan/Blue Care Network–sponsored quality initiative. A total of 29,170 eligible patients were identified. The primary endpoint for analysis was the percentage of patients who received at least one advanced imaging test within 90 days after diagnosis of breast cancer. All demographic, imaging, and pathologic data were taken from medical records.
Of that cohort, 5954 (20%) received at least one imaging test within 90 days of their initial diagnosis. As the severity of the disease increased, so did the likelihood of patients receiving tests. On average, only 6% of patients with stage 0 breast cancer underwent imagining scans compared with 53% of those with stage 2B. However, rates for tests were highly variable among the different institutions, with rates of 3-45% for stage 0 and 24-85% for stage 2B.
Subsequent analysis revealed that black race, hormone receptor–negative disease, HER2–positive disease, and higher–grade cancer were significantly associated with higher rates of advanced imaging procedures.
From those results, Dr Henry concluded on behalf of her team that there was considerable variability in the ordering of staging scans for patients diagnosed with early stage breast cancer across Michigan. She also called for more research into the factors underlying the continued use of these scans to develop interventions for rate reduction.
