title: The excessive cost of baseline diagnostic imaging in early breast cancer.
abstract: Many patients with newly diagnosed breast cancer undergo multiple staging investigations. We aimed to assess the use and yield of baseline diagnostic imaging in early-stage breast cancer. A review of all patients diagnosed with breast cancer over five years at a single institution was carried out. 781 patients were included. At diagnosis 266 (34%) patients underwent a bone scan, which showed metastases in 42 (15.8%), of whom 26 (61.9%) were symptomatic with pain. Only two asymptomatic patients had incidental skeletal metastases detected at an estimated cost of euro 50,850 per case. 261 (33.4%) patients underwent hepatic ultrasonography, which showed metastases in 23 (8.8%), of whom 19 (82.6%) had abnormal liver blood tests. Only two patients had incidental hepatic metastases detected at an estimated cost of euro 29,400 per case. The routine use of these imaging modalities to detect metastases in asymptomatic early-stage breast cancer patients is not justified.
authors.affiliation: Academic Unit of Clinical and Molecular Oncology, St James's Hospital and Trinity College Dublin, Dublin.
authors.forename: P G
authors.initials: PG
authors.lastname: Morris
authors.forename: M
authors.initials: M
authors.lastname: O'Connor
authors.forename: C
authors.initials: C
authors.lastname: O'Rafferty
authors.forename: R
authors.initials: R
authors.lastname: Sheikh
authors.forename: J
authors.initials: J
authors.lastname: Gray
authors.forename: R
authors.initials: R
authors.lastname: McDermott
authors.forename: T
authors.initials: T
authors.lastname: Boyle
authors.forename: M J
authors.initials: MJ
authors.lastname: Kennedy
mesh_terms: D000410:Alanine Transaminase; D015415:Biomarkers; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000473:pathology; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D006801:Humans; D007494:Ireland; D008099:Liver / Q000000981:diagnostic imaging; D008111:Liver Function Tests; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase