Imaging Use in Breast Cancer Grows, Despite Evidence Gap

Charles Bankhead

February 2011, Vol 2, No 1 -

San Antonio, TX—Results of an Italian study showed that use of newer imaging studies in early breast cancer has increased substantially despite a lack of evidence for benefits.

Per-patient use of computed tomography (CT), positron-emission tomography (PET), and magnetic resonance imaging (MRI) roughly doubled from 2005 to 2008. During the same period, use of routine imaging—such as mammography and chest x-ray—remained stable or increased slightly, resulting in an overall increase in imaging studies.

Use of these newer imaging modalities for routine imaging of patients with early breast cancer “has been steadily growing over the past 4 years, with important cost implications,” Grazia Arpino, MD, PhD, of Universita di Napoli Federico II in Naples, Italy, reported at the San Antonio Breast Cancer Symposium. “Further studies are needed to characterize patient subsets that deserve these more invasive staging and follow- up procedures.”

Current clinical guidelines for breast cancer do not support routine use of newer imaging studies, including CT, PET with fluorodeoxyglucose (FDG), or MRI. Nonetheless, imaging studies are requested with increasing regularity, even in the absence of clear clinical indications, Dr Arpino and colleagues noted in a poster presentation.

To quantify the change in volume of newer imaging studies in breast cancer, investigators performed a retrospective cohort study, based on medical records provided by 457 phy sicians involved in the care of patients with breast cancer. They identified patients with new diagnoses of early breast cancer from 2005 through 2008 and assessed the use of all imaging studies for those patients.

The number of new cases of early breast cancer declined from 576 in 2005 to 467 in 2008, and the use of CT imaging increased from 0.55 procedures per patient to 1.02 (P <.001). The rate of FDG-PET imaging in creased from 0.07 to 0.14 per patient (P = .004), and MRI use increased from 0.14 to 0.23 per patient (P = .023).

In addition, small but significant changes occurred in the use of abdominal ultrasound and bone density scans. The rate of use did not change significantly for mammography chest x-ray or bone scintigraphy