The Great Lakes State is seeing rampant inconsistency statewide in the utilization of staging scans when women are diagnosed with early-stage breast cancer, and much of the variability owes to imaging orders that buck national guidelines.

The problem came to light in a study of 25 hospitals and satellite sites performing scans between 2008 and 2014 as part of the Michigan Breast Oncology Quality Initiative.

Led by Norah Lynn Henry, MD, University of Michigan, researchers found that, of 29,170 women with stage 0-IIB breast cancer in the study cohort, 20 percent (5,954) had at least one advanced-imaging test—CT, PET or bone scan—performed within 90 days of diagnosis.

National practice guidelines recommend ordering advanced imaging only for early-stage patients who have symptoms or blood test abnormalities.

In the study, the rates of testing varied widely by cancer stage, with the lowest average rates for women with stage 0 breast cancer (6 percent) and the highest for stage IIB (53 percent).

Also:

• Up to 60 percent of the cases could not be medically justified during the Henry et al. retrospective review.
• Black women and women who had hormone receptor-negative, HER2-positive or higher grade cancer were more likely to be sent for advanced imaging. 
• There was significant site-by-site variability in testing rates. At some hospitals, more than two-thirds of women with stage II disease received advanced imaging exams.

Members of the study team will present their findings in Phoenix on Feb. 27 at the 2016 Quality Care Symposium of the American Society of Clinical Oncology (ASCO).

ASCO points out in a press release that advanced imaging has been decreasing over time for women with stage 0, I, and IIA breast cancer, especially since the launch of the American Board of Internal Medicine’s Choosing Wisely campaign.

However, the group notes, the new study shows that the rate of such testing for patients with stage IIB disease has remained high.

“The chance of finding cancer that has spread to other parts of the body on a scan is only about 1 percent for a woman with stage I or stage II breast cancer,” Henry states. “It’s concerning that so many women are receiving tests that have little benefit to them but may lead to excessive radiation exposure, invasive procedures, anxiety and financial hardship.”

Henry and co-authors add that their findings are consistent with prior studies in other parts of the country, “affirming the need to reduce the rates of inappropriate testing nationwide.”

The researchers say they intend to look into the reasons uncalled-for tests are being ordered and then recommend interventions, including decision tools, for practitioners and patient educators.