Study suggests many women with early breast cancer receive unnecessary imaging tests
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Alexandria, Va. — A new study suggests that up to 60 percent 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. 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 percent for a woman with stage I or stage II breast cancer,” said lead study author N. Lynn Henry, M.D., Ph.D., an associate professor of internal medicine at the University of Michigan Medical School. “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.”
Of 29,170 women with stage 0-IIB breast cancer studied, 5,954 (20 percent) 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 rates for women with stage 0 breast cancer (6 percent) and the highest for stage IIB (53 percent).
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.
Women who were black or who had hormone receptor-negative, HER2-positive, or higher grade cancer were more likely to undergo advanced imaging. There was significant variability in testing rates among the different practices, with more than two-thirds of women with stage II disease undergoing scans at some hospitals.
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 of the underlying reasons such tests are being ordered and develop interventions including decision tools for practitioners and patient education.
“The scans we have today are very sensitive, meaning they pick up many small abnormalities, most of which are never going to be clinically important,” Henry says. “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.”
This study and the Michigan Breast Oncology Quality Initiative received funding from Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.
The findings will be shared at the 2016 ASCO Quality Care Symposium, Feb. 26-27, 2016