Featured Research

from universities, journals, and other organizations

Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures

Date:
December 13, 2013
Source:
University of Texas M. D. Anderson Cancer Center
Summary:
More than one third of younger, early stage breast cancer patients undergo unnecessary imaging procedures at the time of staging and diagnosis, according to research. Often, doctors think they’re not being good to their patients if they don’t do all they can. Yet there’s been a shift in focus to doing what matters for the patient and what’s proven to improve outcomes, rather than testing for the sake of testing.

More than one third of younger, early stage breast cancer patients undergo unnecessary imaging procedures -- including position emission tomography (PET), computed tomography (CT), nuclear medicine bone scans (NMBS) and tumor markers (TM) -- at the time of staging and diagnosis, according to research from The University of Texas MD Anderson Cancer Center.

Related Articles


Presented at a poster session at the 2013 CTRC-AACR San Antonio Breast Cancer Symposium by Carlos Barcenas, M.D., assistant professor in MD Anderson's Breast Medical Oncology, the study is the first to look at the issue of over-use of staging procedures, including imaging and tumor markers in the diagnosis setting, specifically in younger, early-stage breast cancer patients.

Over-testing and unnecessary procedures extends beyond cancer care across the healthcare continuum. To help address the issue, the American Board of Internal Medicine began "Choosing Wiselyฎ," an initiative encouraging physicians and patients to have conversations that encourage its reduction.

As part of its participation in the national campaign, last year, the American Society of Clinical Oncology (ASCO) generated a "top five list" which recommended against the use of CT, PET, TM and NMBS in the diagnosis and staging of early-stage breast cancer at low risk for metastasis. Rather, treatment guidelines clearly state that for women with early-stage breast cancer, the proper procedures for diagnosis include mammogram, ultrasound, clinical exam and blood work, said Barcenas.

"We've known that overuse of staging procedures is a problem as well it may affect the cost-effectiveness in diagnosing women with early breast cancer," said Barcenas. "With ASCO's inclusion of this issue in its top five recommendations last year as part of its 'Choosing Wisely' campaign, this gave us the idea for the study -- to investigate and understand just how pervasive the problem really is."

For the retrospective study, Barcenas and his colleagues analyzed claims from a national employer-based database of 42,651 women between 2005 and 2010 with an initial diagnosis of breast cancer. All were younger than 65 years old and had undergone a mastectomy, lumpectomy and sentinel lymph node biopsy. Patients who underwent axillary lymph node dissection were excluded from the study because this is considered a surrogate for node-positive disease. Claims for imaging and tumor markers were analyzed between the specific period of three months prior to surgery and one month post-surgery. Researchers stratified for age, geographical location, treatment and insurance coverage, HMO or PPO.

The researchers found that 37 percent of early stage breast cancer patients had at least one claim for an unnecessary staging test, with minimal change in rate of that average over the five-year period. Of note, said Barcenas, 18 percent of the woman had tumor markers performed, which is a staging procedure with no role in the non-metastatic diagnosis setting. Undergoing chemotherapy had the highest association with overuse of staging procedures, with hormone and radiation therapy also associated with overuse.

Barcenas and the team also found regional differences in overuse trends, as well a higher rate of unnecessary procedures in women with PPO insurance coverage compared to those with HMO. Also, women with breast cancer under 35 years old were at higher odds of having one of these tests, he explained. Yet when diagnosed at such a young age, this patient population is perceived by the physician to be at higher risk of metastatic and/or aggressive disease.

"While hypothesis-generating, our study is not without limitations. For example, we don't know the receptor status of the tumor, or if the patients had a more aggressive pathology, such as triple negative disease, or if they presented with specific clinical characteristics -- such as back pain or an elevated blood level of a liver function test -- that called for more investigation. In some instances, there will be justification for the additional imaging procedures," said Barcenas.

The researchers plan to follow this trend to see if the rate of unnecessary imaging drops with the continued dissemination of the "Choosing Wisely" campaign. They also plan well to evaluate for cost effectiveness.

Sharon Giordano, M.D., professor and chair, Health Services Research at MD Anderson, thinks the findings clearly support the need for the ASCO recommendations. She said the research shed some light on the issue of over-use and over-care and offers validation to physicians so that they have permission not to order unnecessary tests.

"Often, doctors think they're not being good to their patients if they don't do all they can. Yet there's been a shift in focus to doing what matters for the patient and what's proven to improve outcomes, rather than testing for the sake of testing," said Giordano, also professor in Breast Medical Oncology and the study's senior author. "Ultimately, our goal is to bring the best care and value care to our patients."


Story Source:

The above story is based on materials provided by University of Texas M. D. Anderson Cancer Center. Note: Materials may be edited for content and length.


Cite This Page:

University of Texas M. D. Anderson Cancer Center. "Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures." ScienceDaily. ScienceDaily, 13 December 2013. <www.sciencedaily.com/releases/2013/12/131213092852.htm>.
University of Texas M. D. Anderson Cancer Center. (2013, December 13). Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2013/12/131213092852.htm
University of Texas M. D. Anderson Cancer Center. "Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures." ScienceDaily. www.sciencedaily.com/releases/2013/12/131213092852.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Rural India's Low-Cost Sanitary Pad Revolution

Rural India's Low-Cost Sanitary Pad Revolution

AFP (Nov. 28, 2014) — One man hopes his invention -– a machine that produces cheap sanitary pads –- will help empower Indian women. Duration: 01:51 Video provided by AFP
Powered by NewsLook.com
Research on Bats Could Help Develop Drugs Against Ebola

Research on Bats Could Help Develop Drugs Against Ebola

AFP (Nov. 28, 2014) — In Africa's only biosafety level 4 laboratory, scientists have been carrying out experiments on bats to understand how virus like Ebola are being transmitted, and how some of them resist to it. Duration: 01:18 Video provided by AFP
Powered by NewsLook.com
Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) — The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Experimental Ebola Vaccine Shows Promise In Human Trial

Experimental Ebola Vaccine Shows Promise In Human Trial

Newsy (Nov. 27, 2014) — A recent test of a prototype Ebola vaccine generated an immune response to the disease in subjects. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins