ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- De-implementing low-value care in cancer care delivery: a systematic review.Implementation science : IS · 2022Pooled it
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- Overuse of Health Care Services in the Management of Cancer: A Systematic Review.Medical care · 2017Pooled it
- Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.BMC medical imaging · 2022Article
- The Rethinking Clinical Trials (REaCT) Program. A Canadian-Led Pragmatic Trials Program: Strategies for Integrating Knowledge Users into Trial Design.Current oncology (Toronto, Ont.) · 2021Review
- Staging Investigations in Asymptomatic Early Breast Cancer Patients at the Cancer Centre of Southeastern Ontario.Current oncology (Toronto, Ont.) · 2021Article
- Clinicopathologic Features Predictive of Distant Metastasis in Patients Diagnosed With Invasive Breast Cancer.JCO global oncology · 2020Article
- Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer.Current oncology (Toronto, Ont.) · 2020Article
- Unwarranted imaging for distant metastases in patients with newly diagnosed ductal carcinoma in situ and stage I and II breast cancerCanadian journal of surgery. Journal canadien de chirurgie · 2020Article
- Real-world data: towards achieving the achievable in cancer care.Nature reviews. Clinical oncology · 2019Review
- A critical review of the chest CT scans performed to detect asymptomatic synchronous metastasis in new and recurrent breast cancers.World journal of surgical oncology · 2019Article
- Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France.PloS one · 2019Article
- Factors associated with imaging in patients with early breast cancer after initial treatment.Current oncology (Toronto, Ont.) · 2018Article
- Does adjuvant radiation therapy benefit women with small mammography-detected breast cancers?Current oncology (Toronto, Ont.) · 2017Article
- Use and Yield of Baseline Imaging and Laboratory Testing in Stage II Breast Cancer.The oncologist · 2016Article
- Physicians don't follow guidelines: What are we to do?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2016Article
- Cost implications of unwarranted imaging for distant metastasis in women with early-stage breast cancer in Ontario.Current oncology (Toronto, Ont.) · 2016Article
- Distant metastasis detected by routine staging in breast cancer patients participating in the national German screening programme: consequences for clinical practice.SpringerPlus · 2016Article
- Breast cancer: The importance of overdiagnosis in breast-cancer screening.Nature reviews. Clinical oncology · 2016Article
- Investigations for patients with early-stage breast cancer: oversetting the stage.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015Article
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Authors and funding
9 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPractice 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.
methodsWe 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.
resultsOf 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.
interpretationDespite 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.
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