Staging imaging for metastatic disease in patients with early-stage breast cancer: What do physicians think of the ASCO top-5 recommendation?
Authors: Demetrios Simos, Brian Hutton, Ian D Graham, Jean-Michel Caudrelier, Angel Arnaout, Mark Clemons
Journal: Journal of Clinical Oncology (2014)

Article Tools Health Services Research Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/jco.2014.32.15_suppl.6596 Journal of Clinical Oncology - published online before print May 20, 2014 Staging imaging for metastatic disease in patients with early-stage breast cancer: What do physicians think of the ASCO top-5 recommendation? Demetrios SimosxDemetrios SimosSearch for articles by this author , Brian HuttonxBrian HuttonSearch for articles by this author , Ian D GrahamxIan D GrahamSearch for articles by this author , Jean-Michel CaudrelierxJean-Michel CaudrelierSearch for articles by this author , Angel ArnaoutxAngel ArnaoutSearch for articles by this author , Mark ClemonsxMark ClemonsSearch for articles by this author Show More Division of Medical Oncology, The Ottawa Hospital Cancer Center, University of Ottawa & The Ottawa Hospital Research Institute, Ottawa, ON, Canada; The Centre for Practice Changing Research, University of Ottawa & The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa & The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, University of Ottawa & The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Center, University of Ottawa & The Ottawa Hospital Research Institute, Ottawa, ON, Canada Abstract Disclosures https://doi.org/10.1200/jco.2014.32.15_suppl.6596 Abstract Abstract 6596 Background: In 2012, ASCO’s inaugural "Top 5" list recommended against the routine use of imaging to look for metastases in asymptomatic women with early breast stage cancer. Despite this recommendation being in close agreement with published guidelines, staging imaging is frequently over-utilized. The objective of this study was to determine physicians views on the ASCO "Top 5" and guidelines pertaining to staging imaging for metastatic disease. Methods: A questionnaire was developed and circulated electronically using a modified Dillman technique to Canadian medical, radiation, and surgical oncologists. Results: The questionnaire was completed by 173 physicians (26% response rate). 82% indicated awareness of at least one published guideline on this issue. 60% indicated that they had read the ASCO recommendation and of those, 81% agreed with it. 24% indicated that the ASCO recommendation has influenced them to order less staging imaging. The percentage of respondents who would seldom order imaging for stage 1, 2 and 3 disease was 88%, 37% and 2% respectively. >95% of physicians identified a suspicious history, physical exam, and inflammatory breast cancer as important factors to be taken into consideration when deciding whether or not imaging should be done. The majority did not feel patient demand, fear of litigation or ease of access to imaging were important indications for imaging. Conclusions: Despite awareness of and general agreement with the staging imaging recommendations of the ASCO "Top 5" for early breast cancer, most physicians who treat breast cancer patients have not reduced their use of perioperative imaging. Disease stage, clinical evaluation, and tumour biology were identified as the most important factors influencing their decision of whether to do or not do staging imaging. Alternative strategies, beyond simply publishing recommendations, are therefore required if there is to be a sustained change in physician behaviour. © 2014 by American Society of Clinical Oncology