title: Routine cardiac evaluation in patients with early-stage breast cancer before adjuvant chemotherapy.
abstract: BACKGROUND
  This population-based study of women diagnosed with early-stage breast cancer aimed to (i) determine the current utilization pattern of multigated acquisition (MUGA) scans before adjuvant chemotherapy (AdjC) treatment, and (ii) examine the impact of MUGA scan results on AdjC decision making.
  
  
  METHODS
  All women who underwent curative-intent surgery for stage I-III breast cancer between October 2005 and September 2006 in Nova Scotia, Canada, were identified through the provincial cancer registry. A retrospective chart review was performed to abstract all relevant clinical-pathologic variables, including baseline cardiac risk factors. The association between MUGA scan utilization and clinical-pathologic variables, as well as receipt and type of AdjC, was examined through univariate and multivariate analyses.
  
  
  RESULTS
  The study included 593 women, of whom 238 (40%) received AdjC (94% anthracycline vs. 6% nonanthracycline) and 198 (33%) underwent baseline MUGA scans. Of those received AdjC, 80% underwent MUGA scans. MUGA scan utilization was associated with AdjC treatment (yes vs. no; P < .0001), Her-2/neu status (positive vs. negative vs. not tested; P < .0001), and AdjC regimen (anthracycline vs. nonanthracycline; P < .0001). Abnormal MUGA results were observed in 5 (2.5%) of 198; all were smokers, and 4 were >65 years of age. In the 1 patient <50 years old, subsequent echocardiograms indicated normal cardiac function.
  
  
  CONCLUSIONS
  Routine baseline MUGA scans before AdjC were abnormal and changed the AdjC treatment decision in only 2.5% and 2.0% of patients, respectively. Routine MUGA scans before anthracycline-based AdjC without trastuzumab, however, did not influence AdjC decisions for younger patients <65 years of age without underlying cardiac risk factors.
authors.affiliation: Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. alwin.jeyakumar@cdha.nshealth.ca
authors.forename: Alwin
authors.initials: A
authors.lastname: Jeyakumar
authors.forename: Jillian
authors.initials: J
authors.lastname: DiPenta
authors.forename: Stephanie
authors.initials: S
authors.lastname: Snow
authors.forename: Daniel
authors.initials: D
authors.lastname: Rayson
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.forename: Chris
authors.initials: C
authors.lastname: Theriault
authors.forename: Tallal
authors.initials: T
authors.lastname: Younis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D009674:Nova Scotia; D010818:Practice Patterns, Physicians'; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents