| Abstrakt: |
Background: In October 2013, the American Society of Clinical Oncology (ASCO) recommended avoiding routine staging in patients with newly diagnosed early-stage (clinical stage I/II) breast cancer as part of the Choosing Wisely initiative. Our study examines the impact of adopting ASCO imaging recommendations at an academic medical center in a retrospective cohort. Methods: Patients diagnosed with breast cancer at the University of Vermont Cancer Center (UVMCC) between October 1, 2011, and September 30, 2013, were identified. For those who had undergone staging imaging, the indications, results, costs, and changes in management were assessed. Staging imaging was categorized as "indicated" if patients had signs or symptoms suggestive of metastases or "nonindicated" when none of these factors was present. Results: During the study period, 683 women were diagnosed with breast cancer; 13.9% (95/683) underwent staging, of which 69.5% (66/95) had clinical stage I/II disease. Nonindicated staging was performed in only stage I/II patients and identified no cases of metastatic disease. For the entire cohort, indicated staging had significantly greater detection of metastatic disease (21.9% vs 0%; P <.001) and changes in patient management (21.9% vs 1.85%; P <.01). The false-positive rate of staging was higher in the nonindicated group but not significantly different (37% vs 20%; P = .07). The total cost of nonindicated staging imaging was $5720 per patient. Conclusions: Adopting ASCO recommendations for imaging may improve patient care and lead to cost savings. Implications for Practice: We have shown that changing practice to use the staging criteria proposed by ASCO's Choosing Wisely recommendations decreases the numbers of total imaging studies, false-positive scans, and imaging costs, without modifying the detection of asymptomatic metastases. Staging scans in patients with stage I/II breast cancer are unlikely to guide clinical decision, mainly due to the rarity of asymptomatic metastases. The use of criteria-based imaging saves nearly $6000 per patient. Recent studies suggest that despite ASCO's Choosing Wisely recommendations, women with early-stage breast cancer continue to receive unnecessary imaging evaluations, highlighting the need for ongoing educational efforts regarding these recommendations. [ABSTRACT FROM AUTHOR] |
