Abstract P5-15-03: Imaging is not indicated in staging of asymptomatic patients with early breast cancer – Are we following current recommendations?
Authors: Velazquez AI , Nguyen NT , Rodriguez-Bonilla C , Shao T 
Published: May 2019

Breast cancer is the most common malignancy in women with estimated care costs of $20.50 billion/year by 2020. In 2012, ASCO released the Choosing Wisely Initiative which recommended against the use of routine staging imaging in patients with newly diagnosed early stage breast cancer. We examined physician's adherence rate and factors associated with non-adherence to current guidelines in patients with early stage breast cencer treated within a large urban health care system.

We identified all women with stage I-II breast cancer diagnosed between January 1, 2014 and December 31, 2015 from the Cancer Registry of the Mount Sinai Health System. Patients with history of prior malignancy or symptom-triggered imaging were excluded. Demographic, clinical and treatment related factors were collected. Medical records were reviewed to identify patients who had routine staging scans. Data of initial and follow-up imaging over 1-year period were collected. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models.

Among 917 breast cancer patients, the median age at diagnosis was 59 years (range 26-98). One hundred seventy one patients (18.6%) had routine staging imaging with a mean number of initial scans of 1.48. Eighty-two patients (48%) had at least 1 subsequent scan in the 1-year follow up (range 1-4 scans/year). PET/CT was the most frequent modality (49%), followed by CT scan (33%). The medical oncologist was the ordering provider in 50.3% of the cases and surgical oncologist in 43.2%. Routine staging scans identified no cases of metastatic disease. False-positive findings were identified in 49.7% and incidental findings in 9.3% of cases. Total cost of imaging in this group was $3990/patient. Young age (&lt;50 years old), tumor size &gt;2cm, positive lymph nodes, and triple negative disease were associated with presence of routine staging scans on univariate and multivariate analysis (Table 1).

Our study highlights the prevalence of unnecessary staging scans in up to 18.6% of patients with early stage I-II breast cancer. Routine imaging resulted in increased radiation exposure, multiple subsequent imaging, and increased economical burden particularly for those of young age, T2 tumors, positive lymph nodes, and triple negative disease. Further educational efforts are needed to avoid unnecessary scans in patients with early stage breast cancer and improve high-value practices among medical and surgical oncologists.

Factors associated with routine staging scans in early breast cancer OR95% CIp-value Univariate Analysis:   Age &lt; 501.691.17-2.420.005T2 tumors4.353.01-6.28&lt;0.0001Positive lymph nodes5.073.43-7.51&lt;0.0001Triple negative disease2.941.86-4.63&lt;0.0001 Multivariate Analysis:   Age &lt; 501.571.03-2.390.037T2 tumors3.472.34 -5.17&lt;0.0001Positive lymph nodes4.042.64-6.18&lt;0.0001Triple negative disease2.991.76-5.05&lt;0.0001

Citation Format: Velazquez AI, Nguyen NT, Rodriguez-Bonilla C, Shao T. Imaging is not indicated in staging of asymptomatic patients with early breast cancer – Are we following current recommendations? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-03.