Up to 60% of the computed tomography (CT) scans, bone scans, and positron emission tomography (PET) scans performed for more than 29,000 Michigan women diagnosed with early breast cancer between 2008 and 2014 could not be medically justified based on retrospective record review, according to the findings of a study presented at the 2016 Quality Care Symposium.1 National guidelines recommend against the use of such tests to look for metastases in women with early-stage breast cancer unless a woman has symptoms or blood test abnormalities.
“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,” said lead study author Norah Lynn Henry, MD, Associate Professor of Internal Medicine, University of Michigan, Ann Arbor. “It’s 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.”
Study Details
Of 29,170 women with stage 0–IIB breast cancer studied, 5,954 (20%) had at least one imaging test performed within 90 days of diagnosis. The rates of testing varied widely by cancer stage, with the lowest average rate for women with stage 0 breast cancer (6%) and the highest average rate for women with stage IIB breast cancer (53%).
Advanced imaging has been decreasing over time for women with stage 0, I, and IIA breast cancer, especially since the launch of the American Board of Internal Medicine Choosing Wisely campaign. However, this study indicates that the rate of such testing for patients with stage IIB disease has remained high.
The study included 25 hospitals in the Michigan Breast Oncology Quality Initiative, a Blue Cross Blue Shield of Michigan/Blue Care Network initiative to improve breast cancer care across the state. The Quality Initiative includes physicians in a variety of practice settings, including urban, suburban, and rural and academic and community.
According to the authors, these findings are consistent with prior studies in other parts of the country, affirming the need to reduce the rates of inappropriate testing nationwide. The researchers plan to closely examine the underlying reasons such tests are being ordered and develop interventions including decision tools for practitioners and patient education.
Be sure to watch for further coverage of abstracts from the 2016 Quality Care Symposium in upcoming issues of The ASCO Post. ■
Disclosure: For full disclosures of the study authors, view the abstracts at meetinglibrary.asco.org.
Reference
1. Henry NL, Braun T, Lusk, E, et al: Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry. 2016 ASCO Quality of Care Symposium. Abstract 287. Presented February 26, 2016.
