Imaging Performed on Breast Cancer Patients Despite Recommendations

Imaging for metastases of asymptomatic patients with early-stage breast cancer continues, despite ASCO 2012 recommendations to the contrary, according to a study published in Journal of Oncology Practice.

Canadian researchers sought to determine if one recommendation of five issued by ASCO in 2012, that of ceasing routine advanced costly imaging technologies for staging of early breast cancer, was followed in local practices.

They performed a retrospective review of staging imaging for distant metastases performed in 200 patients with primary operable (early-stage) breast cancer seen at a large Canadian academic cancer center. One hundred patient records were from 2011, before the recommendations were issued, and 100 after September 2012.

The results showed that 169 patients (84.5%) underwent at least one imaging test, with a mean of 3.6 tests per imaged patient. A total of 154 patients (77.0%) underwent imaging that did not follow the local guideline recommendations. The researchers found that the frequency of imaging did not change after ASCO published its recommendations. “Furthermore, imaging to clarify indeterminate initial imaging was required in 51 (30.2 percent) of 169 patients,” the authors wrote. “None of the confirmatory imaging results ultimately revealed metastatic disease.”

The researchers concluded that although the local imaging guidelines advised against imaging for distant metastases in early-stage breast cancer, there was no reduction of imaging use in this population. “Broader knowledge translation strategies beyond publication are needed if recommendations are to be implemented into routine clinical practice,” they wrote.