Quality and Efficiency of Staging Tests in Breast Cancer Patients

Key findings

Overall, the number of early stage breast cancer patients who receive imaging for staging to detect metastases is declining. This pattern follows the desired direction for quality and efficiency of staging tests in breast cancer, but there is still work to be done to reduce this testing.

Why is this important to Ontarians?

• Most women with a new diagnosis of breast cancer present with early stage disease (stages 1 and 2).^[1] In early stage breast cancer, the disease is limited to the breast tissue. This is in contrast to late stage breast cancer, where the disease has spread to other organs and tissues. These tumour deposits are known as metastases.
• Baseline imaging tests to detect metastases include bone scans, liver ultrasonography and computed tomography (CT).^{[2] [3]}
• Most practice guidelines do not recommend imaging for early stage (stages 1 and 2) breast cancer patients who have no symptoms of metastatic disease.^{[4] [5]} Reasons include extremely low detection rates,^[6] and likelihood of incidental findings that have no clinical significance but that may lead to unnecessary further testing and needless anxiety for patients. In general, this extra imaging does not improve patient care and may be detrimental, delaying treatment while the patient undergoes testing and contributing to healthcare costs without clinical benefits.

See Quality & Efficiency of Staging Tests in Breast Cancer Patients Methodology for technical information.