guidelines from top cancer institutions including the American Society of
Clinical Oncology, Cancer Care Ontario, and the National Comprehensive Cancer
Network recommend against this testing.
study highlighted that despite standard guidelines that advise against the
testing to investigate possible metastases in asymptomatic patients with stage
I or II breast
, most women still prefer undergoing it. The institutions
recommend against the testing because the likelihood of metastases - the growth
of secondary cancer cells at a distance from a primary site of cancer - is low,
at 0.2% for stage I breast cancer and 1.2% for stage II breast cancer patients.
Also, the chances of false-positive findings are high.
testing could lead to false-positive results, more invasive tests, delays in
treatment and unnecessary concern.
guidelines against imaging to detect radiologically evident distant metastases,
our results show that this practice is very common among patients with
early-stage breast cancer in Ontario," writes Dr. Mark Clemons at The
Ottawa Hospital and the University of Ottawa, Ontario.
study involved as many as 26547 women from Ontario, who were diagnosed with
stage I or stage II breast cancer between the years 2007 and 2012. The
researchers found that about 86% of participants (as many as 22811 women)
underwent at least one imaging test to discover whether cancer had
average number of imaging tests conducted per patient was 3.7 in the pre- and
postoperative periods. Surgeons and oncologists order most tests. Surgeons
recommended 74% of preoperative tests and
oncologists ordered about 41% of postoperative examinations.
study recognized that the use of modern imaging, such as computed tomography
, magnetic resonance imaging
and positron emission
tomography, to identify possible metastases has increased significantly. The
utilization of latest imaging now comprises 41% of all initial tests.
study also notes variability in use of imaging between geographic regions and
between community healthcare centers and academic institutions.
guideline recommendations are to be implemented in practice, additional
knowledge translation strategies are needed, as dissemination of clinical
practice guidelines alone is not an effective method of changing physician
practice behaviors. These strategies will also require patient
engagement," conclude the researchers.
on the study, Drs. Daniel Rayson and Geoff Porter of Queen Elizabeth II Health
Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada, say
that "both surgical and oncological teams may order examinations to
reassure and support the worried, newly diagnosed patient and her loved ones -
clearly praiseworthy goals. People are often blindsided by a cancer diagnosis
and depend on their healthcare team to be as certain as possible that their
illness can be cured, and they are not dying."
the commentary authors said that the testing has a cascading effect.
Suggestions for more confirmatory examinations have increased wait times for
test results. Also, possible treatment can heighten the patient's anxiety
and increase their healthcare costs.
Demetrios Simos, Christina Catley, Carl van Walraven, Angel Arnaout,
Christopher M. Booth, Matthew McInnes, Dean Fergusson, Susan Dent, Mark
Clemons. Imaging for distant metastases in women with early-stage breast
cancer: a population-based cohort study. CMAJ, June 2015 DOI: 10.1503/cmaj.150003