title: Imaging for metastatic disease in patients with newly diagnosed breast cancer: are doctor's perceptions in keeping with the guidelines?
abstract: OBJECTIVE
  Despite multiple guidelines advocating against routine radiological evaluation for metastases in women with early stage breast cancer, imaging is still frequently overused. The objective of this study was to assess doctor's views on imaging guidelines, and an attempt to establish why personal and local clinical practice patterns regarding imaging may differ from current guidelines.
  
  
  METHODS
  Canadian doctors who treat breast cancer were invited by email to complete an online survey developed by members of the research team.
  
  
  RESULTS
  Responses were received from 173 physicians (26% response rate). Most (82%) indicated awareness of at least one published imaging guideline. Sixty per cent indicated that they had read the recommendations of the 2012 American Society of Clinical Oncology 'Top 5' list for choosing wisely in oncology imaging and, of those, 81% agreed with it. However, most indicated that this recommendation has not influenced them to order less imaging. Over 95% of doctors identified suspicious history, physical examination findings and inflammatory breast cancer as important factors for performing imaging. The majority did not feel that patient demand, fear of litigation or ease of access to imaging influenced their ordering for imaging.
  
  
  CONCLUSIONS
  The majority of breast cancer doctors are aware of and generally agree that guidelines pertaining to staging imaging for early breast cancer are reflective of evidence. Despite this, adherence is variable and factors such as local practice patterns and disease biology may play a role. Alternative strategies, beyond simply publishing recommendations, are therefore required if there is to be a sustained change in doctor behaviour.
authors.affiliation: Department of Medicine, Division of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Simos
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Angel
authors.initials: A
authors.lastname: Arnaout
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Caudrelier
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D002170:Canada; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000473:pathology; D010358:Patient Participation; D010465:Perception; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
keywords: clinical guidelines; early breast cancer; evidence-based medicine; health services research; questionnaire-designed study; staging imaging