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Overuse of diagnostic treatment prevalent in patients with early stage breast cancer

Many patients with low risk for recurrence still undergo advanced diagnostic imaging to look for metastasis

Limiting advanced imaging tests such as CT scans for patients with early stage breast cancer could improve the quality and reduce the cost of care -- yet a new University of Michigan Comprehensive Cancer Center study shows many patients still receive such tests despite being at low risk for recurrence. Earlier this year, the American Society of Clinical Oncology released its " Top Five list of opportunities to improve quality and value in cancer care."

As part of those recommendations, ASCO advised against the routine use of advanced diagnostic imaging tests in patients treated for early stage breast cancer. These tests are used to assess whether the cancer has spread to other areas of the patient's body.

Image of patient going into scan
Photo by iStockphoto/Thinkstock

However, the U-M study led by Tara Breslin, M.D., assistant professor of surgery, found more than 25% of patients were still undergoing these tests -- which include CT, PET and radionuclide bone scans -- at diagnosis.

The results of the study were presented at the ASCO Quality Forum in San Diego, Calif.

"Despite ASCO's published guidelines, our results show many patients receive these tests, despite their low risk of metastatic disease and recurrence," Breslin says. "These advanced diagnostic tests not only increase the cost of care, but they may also lead to additional testing and anxiety related to test results."

The researchers analyzed data from more than 10,000 patients with breast cancer stages zero, 1 and 2, who were between the ages of 30 and 80. As expected, about 95% of the patients underwent traditional imaging tests to diagnosis their condition, but 25.7% also received advanced imaging tests as well.

The study comes from the Michigan Breast Oncology Quality Initiative, which is funded by Blue Cross Blue Shield and unites the U-M Comprehensive Cancer Center, the National Comprehensive Cancer Network and 25 hospitals in Michigan.

Breslin says the results of the study highlight an opportunity for oncologists to fine-tune diagnostic evaluation for patients with early stage breast cancer.

"Efforts to decrease the use of advanced diagnostic imaging for early stage breast cancer patients with low risk of recurrence should focus on understanding why the tests are ordered and how the results are used to guide further treatment decisions," she says.


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