Cost implications of unwarranted imaging for distant metastasis in women with early-stage breast cancer in Ontario.

K Thavorn, Z Wang, D Fergusson, S van Katwyk, A Arnaout, M Clemons

Abstract read

In one paragraph

Article in Current oncology (Toronto, Ont.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed, 1 pooled it

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

Cost of Low-Value Imaging Worldwide: A Systematic Review.Applied health economics and health policy · 2024
Pooled it
Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data.JCO oncology practice · 2023
Article
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 · 2020
Article
Factors associated with imaging in patients with early breast cancer after initial treatment.Current oncology (Toronto, Ont.) · 2018
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

K ThavornClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON;

Z WangClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON;

D FergussonClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON;

S van KatwykClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;

A ArnaoutDivision of Surgical Oncology, Department of Surgery, Ottawa Hospital, Ottawa, ON;; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON;

M ClemonsDivision of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, and University of Ottawa, Ottawa, ON.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDespite the publication of multiple evidence-based guidelines recommending against routine imaging for distant metastasis in patients with early-stage (i/ii) breast cancer, such imaging is frequently performed. The present retrospective cohort study was conducted to estimate the cost of unnecessary imaging tests in women with stage i and ii breast cancer diagnosed between 1 January 2007 and 31 December 2012 in Ontario.

methodsWe obtained patient-level demographic and tumour data from a large provincial dataset. The total cost of unwarranted imaging tests (in 2015 Canadian dollars) was considered to be equal to the sum of imaging costs incurred between 2007 and 2012 and was stratified by disease stage, imaging modality, and body site.

resultsOf the 26,547 identified patients with early-stage breast cancer, 22,811 (85.9%) underwent at least 1 imaging test, with an average of 3.7 tests per patient (3.2 for stage i patients and 4.0 for stage ii patients) over 5 years. At least 1 imaging test was performed in 79.6% of stage i and 92.7% of stage ii patients. During a 5-year period, the cost of unwarranted imaging in patients with early-stage breast cancer ranged from CA$4,418,139 to CA$6,865,856, depending on guideline recommendations.

conclusionsOur study highlights the substantial cost of excess imaging that could be saved and re-allocated to patient care if evidence-based guidelines are followed. Future studies should assess strategies to ensure that evidence-based guidelines are followed and to increase awareness of the cost implications of nonadherence to guidelines.

Indexed as

Costsearly-stage breast cancerOntariounwarranted imaging for distant metastasis

Identifiers

PMID26985147

DOI10.3747/co.23.2977

PMCPMC4780582

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.