Breast Cancer Patients Face More Imaging Tests Today

Study finds multiple visits common in pre-op period, urges better coordination

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Friday, December 23, 2011

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FRIDAY, Dec. 23 (HealthDay News) -- Women with breast cancer undergo many more imaging tests between diagnosis and surgery than they did in the early 1990s, a new study finds.

The tests -- breast ultrasounds, MRIs and mammograms -- help doctors determine the best course of treatment, but add to the hassles and expense of care, the study says.

"The burden to the patient is increasing substantially," said study leader Dr. Richard Bleicher, an associate professor of surgical oncology at Fox Chase Cancer Center in Philadelphia. For older patients, especially, coordination of care is needed, he said.

Bleicher, a breast surgeon, evaluated data on more than 67,000 women in the United States diagnosed with breast cancer from 1992 to 2005. His intent was to clock the time and inconvenience involved in multiple imaging appointments.

In 1992, he found that 1 in 20, or under 5 percent of patients, had imaging twice or more during the preoperative period of about 37 days. By 2005, 1 in 5 patients, or nearly 20 percent, had two or more imaging sessions.

"Patients are having a lot more imaging done overall," he said. "I can't tell you whether the imaging was appropriate or not appropriate."

The percentage of patients who had more than one type of imaging on a given day increased more than six-fold, from about 4 percent in 1992 to just over 27 percent in 2005, the study found.

A subgroup of 20 patients had five or more mammogram visits during the pre-op period, he found.

For the study, the researchers used Medicare claims linked to the U.S. National Cancer Institute's
Surveillance Epidemiology End Results data for women with breast cancer. They zeroed in on about 67,750 women over age 65 who had invasive cancer that hadn't spread and who were scheduled for surgery.

Bleicher presented the findings earlier this month at the San Antonio Breast Cancer Symposium. He urged his colleagues to consider ways of streamlining the testing, with an eye to improving treatment without raising costs.

The increase in imaging tests does not surprise Dr. Carol Lee, head of the communications committee for the American College of Radiology Breast Imaging Commission.

"Practices have changed," she said. "Standards of care have changed." Since 1992, imaging technology has advanced greatly, she said, noting there are more, and better, options.

One limitation of the study, she said, is that the outcomes are not addressed. "This is not telling the whole story," she said. "What gets lost in the numbers is, what are the possible benefits of this additional imaging?"
"Yes, we are doing more tests," she said. "But we are not doing tests for the sake of doing tests."

Some states have laws that address self-referral, said Shawn Farley, spokesperson for the American College of Radiology. The specifics of the laws vary.

Lee agreed with Bleicher that doctors should strive for better coordination of imaging tests.

If your doctor orders imaging, Bleicher recommends asking why it's needed. You might also ask if the doctor expects more imaging will be needed and if so, whether it's possible to schedule tests together, he said.

The study was supported by the U.S. Public Health Service, the American Cancer Society, the Commonwealth of Pennsylvania and private donors.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

SOURCES: Richard J. Bleicher, M.D., breast surgeon and associate professor of surgical oncology, Fox Chase Cancer Center, Philadelphia; Carol Lee, M.D., head, communications committee, American College of Radiology Breast Imaging Commission; presentation, San Antonio Breast Cancer Symposium, December, 2011

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