Abstract
PurposeThe probability of detecting radiologically evident metastatic disease in asymptomatic women with newly diagnosed operable breast cancer is low. Despite the recommendations of most practice guidelines imaging is still frequently performed. Relatively little is known about what patients believe is important when it comes to radiologic staging.MethodsPatients with early stage breast cancer who had completed their definitive breast surgery were surveyed about their personal experiences, perceptions, and expectations on the issue of perioperative imaging for distant metastatic disease.ResultsOver a 3 month period, 245 women with primary operable breast cancer completed the questionnaire (87.0% response rate) and 80.8% indicated having had at least one imaging test for distant metastatic disease. These were either of the thorax (72.2%), abdomen (55.9%) or skeleton (65.3%) with a total of 701 imaging tests (average of 3.5 tests per patient imaged) performed. Overall, 57.1% indicated that they would want imaging done if the chance of detecting metastases was ≤10%. Although 80.0% of patients indicated that, “doing whatever their doctor recommended” was important to them, 70.4% also noted that they would be uncomfortable if their physician did not order imaging, even if this was in keeping with practice guidelines.ConclusionsMost patients with early stage breast cancer recall having imaging tests for distant metastases. Given the choice, most would prefer having imaging performed, even if this is not in line with current guidelines. If patient expectations are, in part, driving excessive imaging, new strategies addressing this are required.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-176) contains supplementary material, which is available to authorized users.
Highlights
As this prevalence is significantly lower than the reported false positive rate of contemporary imaging (Brennan and Houssami 2012; Simos et al 2013), local (Laing 2012; Myers et al 2001; Alberta Health Services clinical practice guideline BR-012 version 2 effective July 2012), national (National Comprehensive Network (NCCN) clinical practice guidelines in oncology – Breast Cancer version 1 2014), and international (Senkus et al 2013) practice guidelines all generally recommend against the routine use of imaging
This issue was recently highlighted by the American Society of Clinical Oncology (ASCO) in their inaugural “Top-5” list for oncology in which the use of staging imaging in asymptomatic patients with early breast cancer was discouraged (Schnipper et al 2012). This recommendation is in keeping with the spirit of the published guideline recommendations (Myers et al 2001; Alberta Health Services clinical practice guideline BR-012 version 2 effective July 2012; Laing 2012; National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology – Breast Cancer version 1 2014; Senkus et al 2013)
Of the 196 (80.0%) who indicated that doing whatever their physician recommends is either extremely or very important to them, 138/196 (70.4%) indicated that they would be uncomfortable if their physician did not order imaging to look for metastatic disease
Summary
Newly diagnosed early stage breast cancer frequently undergo imaging for distant metastases (Simos et al 2013; Barrett et al 2009; Al-Husaini et al 2008; McWhirter et al 2007; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998). Many groups have shown that the probability of detecting such metastases is low (Barrett et al 2009; Puglisi et al 2005; Gerber et al.2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998; Al-Husaini et al 2008; Simos et al 2013) with a recent meta-analysis reporting the median prevalence of metastases as 0.2%, 1.2% and 8% in patients with stage 1, 2 and 3 disease respectively (Brennan and Houssami 2012) As this prevalence is significantly lower than the reported false positive rate of contemporary imaging (Brennan and Houssami 2012; Simos et al 2013), local (Laing 2012; Myers et al 2001; Alberta Health Services clinical practice guideline BR-012 version 2 effective July 2012), national (National Comprehensive Network (NCCN) clinical practice guidelines in oncology – Breast Cancer version 1 2014), and international (Senkus et al 2013) practice guidelines all generally recommend against the routine use of imaging. We undertook this study to identify patient experiences with as well as their perceptions and expectations on this matter, and to assess whether or not their views are concordant with existing guidelines
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