Navigation Links
Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures at time
Date:12/12/2013

SAN ANTONIO 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.

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 Wisely," 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."


'/>"/>

Contact: Laura Sussman
lsussman@mdanderson.org
832-264-8893
University of Texas M. D. Anderson Cancer Center
Source:Eurekalert

Related medicine news :

1. Aging – Look Younger, Faster Than Ever Before
2. Stryker Hip Injury Claims Number Nearly 400 in Federal Court, Rottenstein Law Group LLP Reports
3. i2i Systems Ranks as an Early Leader in Population Health Management in New KLAS Report
4. UCSB researcher finds origin of inherited gene mutation causing early-onset Alzheimers
5. DePuy Pinnacle Lawsuit Claims Mount, as Bernstein Liebhard LLP Notes Nearly 6,000 Filings in Federal Pinnacle Hip Litigation
6. With Winter’s Early Arrival, It’s Not Too Late to Install Warm Floors
7. Kids whose bond with mother was disrupted early in life show changes in brain
8. JCI early table of contents for Dec. 2, 2013
9. Orangetheory Fitness Set to Open First Southern Colorado Location in Early 2014
10. Wright Hip Lawsuits News: Nearly 80 Lawsuits Consolidated in Federal Court, Rottenstein Law Group LLP Reports
11. PricingHealthcare.com Releases "Self-Pay" Prices for Common Procedures at Nearly 400 California Hospitals
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... Milwaukee, WI (PRWEB) , ... October 13, 2017 , ... ... movement in medicine known as “patient engagement.” The patient is doing more than filling ... research partners. , “There is an increasing emphasis in health care and research ...
(Date:10/13/2017)... EDWARDSVILLE, Ill. (PRWEB) , ... ... ... University Edwardsville School of Pharmacy (SOP) alumni Hannah Randall, PharmD ‘17, and ... educated healthcare professionals on guideline updates for the primary prevention of cardiovascular ...
(Date:10/13/2017)... ... 13, 2017 , ... Ellevate Network, the leading network for professional women, brought ... gender equality at their inaugural Summit in New York City in June. The event ... audience of over 3 million. To watch the Mobilize Women video, click here ...
(Date:10/13/2017)... ... ... “The Journey: From the Mountains to the Mission Field”: the story of a missionary ... Journey: From the Mountains to the Mission Field” is the creation of published author, ... ages and currently teaches a class of ladies at her church, which she has ...
(Date:10/12/2017)... WAUSAU, Wis. (PRWEB) , ... October 12, 2017 ... ... formulated standard products to meet the demand of today’s consumer and regulatory authorities ... team of probiotic experts and tested to meet the highest standard. , ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)... ORANGE COUNTY, Calif. , Oct. 10, 2017  NDS received ... Mobile  — a medical-grade battery-powered display stand specifically designed for ... aims to transform technology into a clinical solution to support the ... costs. Innovative Design ... NDS ZeroWire Mobile Wireless Solution ...
(Date:10/4/2017)... to the Centers for Disease Control and Prevention (CDC), influenza vaccination ... is helping communities across Massachusetts , Connecticut ... flu shots through the end of the month. *Some exclusions ... ... shot is by the end of October, according to the Centers for ...
(Date:10/2/2017)... , Oct. 2, 2017 Halo Labs announces the European ... system called the HORIZON at MIBio 2017 in Cambridge, ... and visible particulate matter in biopharmaceutical samples with unprecedented speed and ... the novel technique Backgrounded Membrane Imaging. ... The HORIZON subvisible particle analysis system ...
Breaking Medicine Technology: