This was a retrospective analysis to assess the rates of imaging use in breast cancer patients. The study makes use of SEER/Medicare data to analyse the rate of use in comparison to a control cohort.
Use of high tech imaging was 60% higher among breast ca pts than controls. The utilisation is primarily in the 1st year after dx suggesting the imaging is mostly linked to the breast ca. The study also documents an increase into the use of CT, US, MR & Nuc Med studies in both the breast ca pts as well as the controls over the time period.
Limitations of this study are that the 'appropriateness' of indications and the outcome/findings of the studies were not assessed. The exclusion of pts who died or had documented recurrence is also interesting, this likely reduced the utilisation rate in the population, and skews the population towards asymptomatc pts, with studies done for 'follow up malignancy'.
As far as clinical practice, this article doesn't provide any clear guidance as to what we should be doing, but does reinforce that we should be following the ACR/ASCO top 5 lists when ordering/protocolling studies.
PICO Analysis:
Population:
-Medicare recipients (>65yo) 1998-2003
-Stage I-II Primary breast ca (~25000pts)
-EXCLUDED pts with documented recurrence or death.
Intervention: High technology imaging (CT, US, MR, NM) during months 13-48 post-diagnosis.
Comparison: Age-matched random sample of women.
Outcome: Utilization of high tech imaging (HTRI)
Use of high technology imaging for surveillance of early stage breast cancer
Reference: K. S. Panageas et al., Breast Cancer Res Treat (2012) 131:663–67
Links: Pubmed, Full text
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