Are we overstaging our breast cancer patients? - a lesson from one institution
Association of Breast Surgery ePoster Library. Lewis R. 05/15/17; 166184; P083
Ms. Rebecca Lewis
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Abstract
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Introduction
Both NICE and ABS are clear that patients diagnosed with early breast cancer should not be referred routinely for staging investigations. These guidelines are used to prevent unnecessary testing, radiation and anxiety for these patients. There is considerable variability between units regarding which patients are staged. The number of newly diagnosed patients at one centre who had staging were audited, it was determined which of these patients met the guidance.
Methods
The following criteria were used to qualify for staging (i.e. not early stage disease) – recurrence, 4 or more positive lymph nodes in the axilla, and T4 tumours (TNM staging). CT chest abdomen pelvis and bone scan were performed.
Results
In a two year period (2014/2015), 229 patients were diagnosed with breast cancer. 79 of these patients were staged (34.5%), of which 48 patients met the criteria for staging (60.8%). Of the patients who met the guidelines, 31.2% were found to have metastatic disease. Of the 31 patients outside the guidelines, none (0%) were found to have metastasis. This audit was presented within the department in order to highlight the potential benefit in following the guidance. A re-audit of patients for the six months afterwards showed that only 4.5% of patients were staged without meeting the criteria.
Conclusions
There is considerable cost and patient anxiety associated with the staging of patients with early breast cancer. More clarification is needed on what qualifies as an early breast cancer for this purpose. Stricter guidance could prevent unnecessary staging in these patients.
Both NICE and ABS are clear that patients diagnosed with early breast cancer should not be referred routinely for staging investigations. These guidelines are used to prevent unnecessary testing, radiation and anxiety for these patients. There is considerable variability between units regarding which patients are staged. The number of newly diagnosed patients at one centre who had staging were audited, it was determined which of these patients met the guidance.
Methods
The following criteria were used to qualify for staging (i.e. not early stage disease) – recurrence, 4 or more positive lymph nodes in the axilla, and T4 tumours (TNM staging). CT chest abdomen pelvis and bone scan were performed.
Results
In a two year period (2014/2015), 229 patients were diagnosed with breast cancer. 79 of these patients were staged (34.5%), of which 48 patients met the criteria for staging (60.8%). Of the patients who met the guidelines, 31.2% were found to have metastatic disease. Of the 31 patients outside the guidelines, none (0%) were found to have metastasis. This audit was presented within the department in order to highlight the potential benefit in following the guidance. A re-audit of patients for the six months afterwards showed that only 4.5% of patients were staged without meeting the criteria.
Conclusions
There is considerable cost and patient anxiety associated with the staging of patients with early breast cancer. More clarification is needed on what qualifies as an early breast cancer for this purpose. Stricter guidance could prevent unnecessary staging in these patients.
Introduction
Both NICE and ABS are clear that patients diagnosed with early breast cancer should not be referred routinely for staging investigations. These guidelines are used to prevent unnecessary testing, radiation and anxiety for these patients. There is considerable variability between units regarding which patients are staged. The number of newly diagnosed patients at one centre who had staging were audited, it was determined which of these patients met the guidance.
Methods
The following criteria were used to qualify for staging (i.e. not early stage disease) – recurrence, 4 or more positive lymph nodes in the axilla, and T4 tumours (TNM staging). CT chest abdomen pelvis and bone scan were performed.
Results
In a two year period (2014/2015), 229 patients were diagnosed with breast cancer. 79 of these patients were staged (34.5%), of which 48 patients met the criteria for staging (60.8%). Of the patients who met the guidelines, 31.2% were found to have metastatic disease. Of the 31 patients outside the guidelines, none (0%) were found to have metastasis. This audit was presented within the department in order to highlight the potential benefit in following the guidance. A re-audit of patients for the six months afterwards showed that only 4.5% of patients were staged without meeting the criteria.
Conclusions
There is considerable cost and patient anxiety associated with the staging of patients with early breast cancer. More clarification is needed on what qualifies as an early breast cancer for this purpose. Stricter guidance could prevent unnecessary staging in these patients.
Both NICE and ABS are clear that patients diagnosed with early breast cancer should not be referred routinely for staging investigations. These guidelines are used to prevent unnecessary testing, radiation and anxiety for these patients. There is considerable variability between units regarding which patients are staged. The number of newly diagnosed patients at one centre who had staging were audited, it was determined which of these patients met the guidance.
Methods
The following criteria were used to qualify for staging (i.e. not early stage disease) – recurrence, 4 or more positive lymph nodes in the axilla, and T4 tumours (TNM staging). CT chest abdomen pelvis and bone scan were performed.
Results
In a two year period (2014/2015), 229 patients were diagnosed with breast cancer. 79 of these patients were staged (34.5%), of which 48 patients met the criteria for staging (60.8%). Of the patients who met the guidelines, 31.2% were found to have metastatic disease. Of the 31 patients outside the guidelines, none (0%) were found to have metastasis. This audit was presented within the department in order to highlight the potential benefit in following the guidance. A re-audit of patients for the six months afterwards showed that only 4.5% of patients were staged without meeting the criteria.
Conclusions
There is considerable cost and patient anxiety associated with the staging of patients with early breast cancer. More clarification is needed on what qualifies as an early breast cancer for this purpose. Stricter guidance could prevent unnecessary staging in these patients.
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