Imaging tests in staging and surveillance of non-metastatic breast cancer: changes in routine clinical practice and cost implications

Abstract

Background:Although guidelines do not recommend computerised tomography (CT), positron emission tomography (PET) or magnetic resonance imaging (MRI) for the staging or follow-up of asymptomatic patients with non-metastatic breast cancer, they are often requested in routine clinical practice. The aim of this study was to determine the staging and follow-up patterns, and relative costs in a large population of breast cancer patients living and treated in a Southern Italian region.Methods:We analysed the clinical computerised information recorded by 567 primary-care physicians assisting about 650 000 inhabitants in the Campania region. Patients with non-metastatic breast cancer were identified and divided into calendar years from 2001 to 2010. The number of diagnostic tests prescribed per 100 patients (N/Pts) and the mean cost per patient was determined 3 months before diagnosis and up to 1 year after diagnosis. Costs are expressed in constant 2011 euros.Results:We identified 4680 newly diagnosed cases of asymptomatic non-metastatic breast cancer. N/Pts increased significantly (P<0.0001) from 2001 to 2010. The mean number of prescribed mammograms, bone scans, abdominal ultrasound and chest X-rays (‘routine tests'), and costs was unchanged. However, the number of CT, PET scans and MRI (‘new tests')prescriptions almost quadrupled and the mean cost per patient related to these procedures significantly increased from €357 in 2001 to €830 in 2010 (P<0.0001).Conclusions:New test prescriptions and relative costs significantly and steadily increased throughout the study period. At present there is no evidence that the delivery of new tests to asymptomatic patients improves breast cancer outcome. Well-designed clinical trials are urgently needed to shed light on the impact of these tests on clinical outcome and overall survival.

The lingering mysteries of metastatic recurrence in breast cancer

“…149,150 Despite these guidelines, however, many patients receive highcost imaging analysis (CT, brain or body MRI, PET and bone scans) and tumour marker blood tests during routine follow-up exams, exposing them to radiation and increasing healthcare costs. [151][152][153][154] So, what has led to the current precarious balance between the desire to detect recurrence early and clinical guidelines that limit the use of diagnostic tests? Several large studies and clinical trials published between 1994 and 2007 are often cited as evidence against the use of more intensive monitoring for recurrence.…”

Effect of Mesoporous Nano Water Reservoir on MR Relaxivity

“…Among these imaging modalities, molecular imaging is found to be important for the diagnosis of cancer 1 , 2 . Magnetic resonance (MR) imaging has gained interests from many researchers due to its fascinating ability in diagnosis and staging of disease conditions 3 . There are many agents developed in order to enhance the image contrast between normal and affected tissue based on the T1 and T2 relaxation properties.…”

An Online Calculator for Estimating Breast Implant Volume from Imaging

“…3 Chest computed tomography (CT) imaging is less expensive, more readily available, and although not formally recommended by guidelines, frequently implemented for cancer staging or surveillance. 9,10 Our study validated an algorithm created to estimate implant volume using simple measurements from a chest CT scan and introduces a free, interactive, online tool for volume estimation.…”