Quality and Efficiency of Staging Tests in Breast Cancer Patients
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). 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). 
- Most practice guidelines do not recommend imaging for early stage (stages 1 and 2) breast cancer patients who have no symptoms of metastatic disease.  Reasons include extremely low detection rates, 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.
- In 2017, we continued to see steady declines in the percentages of stage 1 and stage 2 breast cancer patients receiving at least 1 imaging test for distant metastases (47% and 80%, respectively).
- As in previous years, more stage 2 breast cancer patients received an imaging test than stage 1 patients. This may be due, in part, to variations in guideline recommendations. Current Cancer Care Ontario guidance indicates bone scanning for stage 2 patients, but Choosing Wisely® does not recommend this test.
- The overall pattern of staging tests in breast cancer patients for both stage 1 and 2 are also on the decline, although there was a slight increase (0.2%) from 2016 to 2017.
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