Cost Implications of Unwarranted Imaging for Distant Metastasis in Women with Early-Stage Breast Cancer in Ontario

Thavorn, Kednapa; Wang, Z.; Fergusson, Dean; Katwyk, Sasha van; Arnaout, Angel; Clemons, Mark

doi:10.3747/co.23.2977

Cited by 8 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, isotopic BS represented the number one cost driver. 8 While it is important to consider the cost of unnecessary image staging, it is also important to consider the consequences of underdiagnosing metastatic diseases at the initial workup. Metastatic BC is indeed an incurable disease, as supported by numerous studies.…”

Section: Discussionmentioning

confidence: 99%

“…3 Because DMs are uncommon in this setting, [4][5][6][7] international guidelines advise against routine imaging of asymptomatic EBC patients. 8,9 The National Comprehensive Cancer Network (NCCN) only recommends imaging procedures in cases of EBC when guided by symptoms (such as bone, respiratory or abdominal pain), or laboratory abnormalities (such as elevated alkaline phosphatase, abnormal liver function), but recommends staging for all stage III patients 2 due to the higher prevalence of occult DMs in this population. 10 Recently, the American Society of Clinical Oncology (ASCO) published recommendations advising against the use of baseline staging in EBC patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Value of Systemic Staging in Asymptomatic Early Breast Cancer

Soares

Pereira

Boas

et al. 2018

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

Objective Metastases are rare in early breast cancer (EBC), and international guidelines recommend against routine systemic staging for asymptomatic patients. However, imaging exams remain widely employed in the clinical practice. The aim of the present study is to evaluate the value of imaging for systemic staging in EBC. Methods A retrospective analysis of newly-diagnosed breast cancer (BC) patients was performed. Clinical data including BC subtype, stage, presence of symptoms at diagnosis and instrumental procedures performed for staging were recorded. Results A total of 753 patients were included, with a median age of 57 years. The majority of the patients underwent at least 1 imaging procedure (91%); had invasive ductal carcinoma (83.5%); histological grade 2 (51.4%); stage II (61.8%); and luminal subtype (67.9%). Among the 685 (91%) patients who underwent any radiologic staging, distant metastases (DMs) were detected in 32 (4.7%). In the univariate analyses, stage IIb and pathological lymph node involvement (pN1) showed a statistically significant association with the presence of DMs, versus only a trend for triple negative and human epidermal growth factor receptor 2 (Her2) positive subtype. In an exploratory analysis performed in this same subgroup, when unfavorable biology (triple negative or Her2 positive) was present, patients had a DM rate of 14.4%, one of the highest reported at this stage of the disease. Conclusion Early breast cancer has a low prevalence of DM at the initial evaluation, and systemic staging of asymptomatic, unselected patients is not warranted as a routine practice. However, we have identified subgroups of patients to whom a full staging could be indicated. ResumoObjetivo Metástases são de ocorrência rara no câncer de mama precoce, e as diretrizes internacionais não recomendam o estadiamento sistêmico de rotina para pacientes assintomáticos. Apesar disso, exames de imagem continuam sendo

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Value of Systemic Staging in Asymptomatic Early Breast Cancer

Soares

Pereira

Boas

et al. 2018

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

show abstract

“…Surveillance imaging in asymptomatic ebc patients who have completed curative treatment does not lead to clinically meaningful improvements in survival 6,7 . Unnecessary imaging has also been shown to increase patient anxiety, health care costs 8,9 , and radiation exposure in a population already vulnerable to secondary malignancies 8,10,11 . Despite the evidence and the guidelines, surveillance imaging continues to occur in breast cancer survivors after curative treatment.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Imaging in Patients with Early Breast Cancer After Initial Treatment

Enright

Desai²,

Sutradhar

et al. 2018

Current Oncology

View full text Add to dashboard Cite

show abstract

“…As the population of breast cancer survivors grows and 5-year survival for localized disease approaches 99%, the development of secondary malignancy can be devastating in terms of morbidity, mortality, and cost for patients who may have achieved complete remission or cure of their initial disease. 7,8,16 The pursuit of additional imaging studies may subject patients to additional anxiety as well as increase cancer-related health care costs. 17 Limitations of this study include those intrinsic to Medicare claims data.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Furthermore, although some studies suggest a potential diagnostic benefit of PET-CT for clinical stage IIB patients, these imaging modalities do not show significant benefit in the detection of distant metastases in early-stage breast cancers with low likelihood of metastatic spread, such as ductal carcinoma in situ and lesions clinically staged as I and IIA. [5][6][7][8] Thus, although CT and PET-CT can be instrumental in the identification of distant metastases in clinically advanced breast cancer, their use in early-stage breast cancers is low in yield relative to false-positive rates. 9 Similarly, radionuclide bone scans and scintigraphy are useful to detect breast cancer that has metastasized to the bone; however, these tests are most appropriate in more highly staged disease and also have low yield in early-stage breast cancers.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data

Baltz

Siegel

Kamal

et al. 2023

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: American Society for Clinical Oncology released the Choosing Wisely list in 2012, highlighting low-value procedures that lack evidence, advising against the use of positron emission tomography, computerized tomography, and radionuclide bone scans for the staging of early-stage breast cancer at low risk for metastasis. The objective of the study was to assess the impact of the American Society of Clinical Oncology Choosing Wisely guidelines on inappropriate staging imaging among early-stage breast cancers. METHODS: The Surveillance, Epidemiology, and End Results Program-Medicare data set was used to identify 50,004 women age 66 years and older with new incident diagnosis of early-stage breast cancer (stage 0 through stage 2a; T < 4, N = 0, and M = 0). The primary outcome was the incidence of patients with inappropriate imaging following an early-stage breast cancer diagnosis. The primary outcome was identified within 6 months of the first diagnosis. An interrupted time series analysis using negative binomial regression was performed for outpatient claims for these diagnostic studies versus the two interruptions of guidelines release and guidelines reinforcement. Mean images per patient, percent change for the study period, and rate of change per year were calculated. RESULTS: Imaging rates fell by a modest 2.32% following guidelines release in April 2012 (point estimate = −2.32%; 95% CI, −6.34% to 1.88%). By contrast, imaging rates fell by a four-fold larger amount (point estimate = −9.36%; 95% CI, −13.20% to −5.35%) following guidelines published reminders in journals (or reinforcement) in October 2013. Mean imaging studies per patient (95% CI) declined from 1.80 (1.76 to 1.84) in January 2012 to 1.50 (1.48 to 1.53) by January 2015, representing a 16% decline in imaging overuse in 2015 compared with 3 years earlier. The rate of change (95% CI) in images per patient was initially small at −0.47% (−4.27% to 3.33%) per year between April 2012 and October 2013, but almost eight times faster at −3.70% (−5.81% to −1.60%) per year after October 2013. CONCLUSION: This analysis demonstrates a substantial decrease in the prevalence of imaging overuse in early-stage breast cancers correlating with the 2013 reinforcement of American Society of Clinical Oncology's 2012 Choosing Wisely guidelines. The creation and dissemination of such resources serves as a powerful tool to improve clinical practice, cost-effectiveness, and patient safety from secondary malignancies, anxiety, and overdiagnosis.

show abstract

Cost Implications of Unwarranted Imaging for Distant Metastasis in Women with Early-Stage Breast Cancer in Ontario

Abstract: Introduction Despite the publication of multiple evidence-based guidelines recommending against routine

Cited by 8 publications

References 11 publications

Value of Systemic Staging in Asymptomatic Early Breast Cancer

Value of Systemic Staging in Asymptomatic Early Breast Cancer

Factors Associated with Imaging in Patients with Early Breast Cancer After Initial Treatment

Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data

Contact Info

Product

Resources

About