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Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study.

Publication ,  Journal Article
Simos, D; Catley, C; van Walraven, C; Arnaout, A; Booth, CM; McInnes, M; Fergusson, D; Dent, S; Clemons, M
Published in: CMAJ
September 8, 2015

BACKGROUND: Practice guidelines recommend that imaging to detect metastatic disease not be performed in the majority of patients with early-stage breast cancer who are asymptomatic. We aimed to determine whether practice patterns in Ontario conform with these recommendations. METHODS: We used provincial registry data to identify a population-based cohort of Ontario women in whom early-stage, operable breast cancer was diagnosed between 2007 and 2012. We then determined whether imaging of the skeleton, thorax, and abdomen or pelvis had been performed within 3 months of tissue diagnosis. We calculated rates of confirmatory imaging of the same body site. RESULTS: Of 26,547 patients with early-stage disease, 22,811 (85.9%) had at least one imaging test, and a total of 83,249 imaging tests were performed (mean of 3.7 imaging tests per patient imaged). Among patients with pathologic stage I and II disease, imaging was performed in 79.6% (10,921/13,724) and 92.7% (11,882/12,823) of cases, respectively. Of all imaging tests, 19,784 (23.8%) were classified as confirmatory investigations. Imaging was more likely for patients who were younger, had greater comorbidity, had tumours of higher grade or stage or had undergone preoperative breast ultrasonography, mastectomy or surgery in the community setting. INTERPRETATION: Despite recommendations from multiple international guidelines, most Ontario women with early-stage breast cancer underwent imaging to detect distant metastases. Inappropriate imaging in asymptomatic patients with early-stage disease is costly and may lead to harm. The use of population datasets will allow investigators to evaluate whether or not strategies to implement practice guidelines lead to meaningful and sustained change in physician practice.

Duke Scholars

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Published In

CMAJ

DOI

EISSN

1488-2329

Publication Date

September 8, 2015

Volume

187

Issue

12

Start / End Page

E387 / E397

Location

Canada

Related Subject Headings

  • Socioeconomic Factors
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Patient Selection
  • Ontario
  • Neoplasm Staging
  • Middle Aged
  • Mastectomy
  • Humans
  • Guideline Adherence
 

Citation

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Simos, D., Catley, C., van Walraven, C., Arnaout, A., Booth, C. M., McInnes, M., … Clemons, M. (2015). Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study. CMAJ, 187(12), E387–E397. https://doi.org/10.1503/cmaj.150003
Simos, Demetrios, Christina Catley, Carl van Walraven, Angel Arnaout, Christopher M. Booth, Matthew McInnes, Dean Fergusson, Susan Dent, and Mark Clemons. “Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study.CMAJ 187, no. 12 (September 8, 2015): E387–97. https://doi.org/10.1503/cmaj.150003.
Simos D, Catley C, van Walraven C, Arnaout A, Booth CM, McInnes M, et al. Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study. CMAJ. 2015 Sep 8;187(12):E387–97.
Simos, Demetrios, et al. “Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study.CMAJ, vol. 187, no. 12, Sept. 2015, pp. E387–97. Pubmed, doi:10.1503/cmaj.150003.
Simos D, Catley C, van Walraven C, Arnaout A, Booth CM, McInnes M, Fergusson D, Dent S, Clemons M. Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study. CMAJ. 2015 Sep 8;187(12):E387–E397.

Published In

CMAJ

DOI

EISSN

1488-2329

Publication Date

September 8, 2015

Volume

187

Issue

12

Start / End Page

E387 / E397

Location

Canada

Related Subject Headings

  • Socioeconomic Factors
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Patient Selection
  • Ontario
  • Neoplasm Staging
  • Middle Aged
  • Mastectomy
  • Humans
  • Guideline Adherence