Too Much Imaging in Stage I and II Breast Cancer Patients

Most imaging among asymptomatic early-stage breast cancer patients is inappropriate and may lead to harm, says a study published in the Canadian Medical Association Journal.

Researchers from Canada sought to determine whether practice patterns in Ontario, Canada, conformed to American Society of Clinical Oncology, Cancer Care Ontario, and the National Comprehensive Cancer Network guidelines, which recommend against imaging for metastatic cancer in asymptomatic women with stage I or II breast cancer.

The study included 26,547 women in Ontario who had been diagnosed with stage I or stage II breast cancer between 2007 and 2012. The researchers determined if the women had undergone imaging of the skeleton, thorax, and abdomen or pelvis within three months of tissue diagnosis. They found that 83,249 imaging tests were performed (mean of 3.7 imaging tests per patient imaged). A total of 85.9% (22,811 women) underwent at least one imaging test. Imaging was performed in 79.6% (10,921 of 13,724) of women with stage I breast cancer and 92.7% (11,882 or 12,823) in those with stage II.

The researchers noted that surgeons and oncologists ordered the most tests, with surgeons ordering (74%) of preoperative tests and oncologists ordering about 41% of postoperative tests.

"Despite guidelines against imaging to detect radiologically evident distant metastases, our results show that this practice is very common among patients with early-stage breast cancer in Ontario," the authors wrote.

A related commentary discusses why extra testing may be done (often to reassure the patient and family), but the authors agree that this testing may have a cascading effect. "It is the responsibility of physicians to be knowledge brokers between the evidence-based guidance and their patients. To do so effectively takes time, energy and good interdisciplinary communication,” the authors wrote. “For most patients with newly diagnosed stage I and II breast cancer, reflexively ordering staging investigations does not help relieve stress, nor does it detect disease," stated the commentary authors.