Many Early-Stage Breast Cancer Patients Undergo Unnecessary Imaging

A study including nearly 30,000 women found that newly diagnosed early-stage breast cancer patients often undergo advanced imaging tests, in spite of recommendations against this practice. Results of the study will be presented at the 2016 American Society of Clinical Oncology (ASCO) Quality Care Symposium, held February 26–27 in Phoenix (abstract 287).

“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 the study’s lead author Norah Lynn Henry, MD, of the University of Michigan in Ann Arbor, in a press release. National guidelines recommend against CT, PET, and bone scans in these women, unless the patient has symptoms or blood test abnormalities.

The new study included prospectively collected data on 29,170 women diagnosed with stage 0–IIB breast cancer at 25 health systems included in the Michigan Breast Oncology Quality Initiative. Of that cohort, 5,954 (20%) underwent at least one imaging test within 90 days of the diagnosis.

The rates of imaging varied across cancer stage. Those with stage 0 disease underwent an imaging scan only 6% of the time, compared with 53% for those with stage IIB breast cancer. On a multivariate analysis, black race, hormone receptor–negative disease, HER2-positive disease, and higher-grade cancer were found to be significantly associated with undergoing advanced imaging. There was also variability between medical centers; in some cases, more than two-thirds of women with stage IIB disease underwent at least one scan.

“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,” Henry said. Many advanced imaging scans will pick up many small abnormalities, most of which will not become clinically relevant. “However, if we find small lung or liver nodules, we often have to keep repeating the scan to make sure those 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 results, it snowballs.”

The authors called for further research into factors underlying the continued use of these scans, and an ASCO spokesperson agreed. Merry-Jennifer Markham, MD, of The University of Florida College of Medicine, who was not involved with the study, said: “It’s troubling that imaging scans are being ordered for many women with stage 0–IIB breast cancer, and this study points to the need for further research as to why this might be occurring so frequently.”