title: ACR Appropriateness Criteria stage I breast cancer: initial workup and surveillance for local recurrence and distant metastases in asymptomatic women.
abstract: Women newly diagnosed with stage 1 breast cancer have an early-stage disease that can be effectively treated. Evidence provides little justification for performing imaging to exclude metastasis in asymptomatic women with stage I breast cancer. No differences have been found in survival or quality of life in women regardless of whether they underwent initial workup for metastatic disease. These women generally prefer intensive follow-up to detect an early recurrence. However, survival rates do not differ between women who obtain intensive screening and surveillance, with imaging and laboratory studies, and women who undergo testing only as a result of development of symptoms or findings on clinical examinations. In addition, quality of life is similar for women who undergo intensive surveillance compared with those who do not. American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that annual mammography is the only imaging examination that should be performed to detect a localized breast recurrence in asymptomatic patients. Additional imaging may be needed if the patient has locoregional symptoms. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review by the panel include extensive analysis of current medical literature from peer-reviewed journals and application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. When evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: NYU Clinical Cancer Center, New York, New York. Electronic address: linda.moy@nyumc.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Moy
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Newell
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mahoney
authors.affiliation: Imagimed, LLC, Rockville, Maryland; American College of Surgeons, Chicago, Illinois.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.affiliation: Invision Sally Jobe, Englewood, Colorado.
authors.forename: Lora D
authors.initials: LD
authors.lastname: Barke
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Selin
authors.initials: S
authors.lastname: Carkaci
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.affiliation: University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Sharad
authors.initials: S
authors.lastname: Goyal
authors.affiliation: University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.affiliation: University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Harvey
authors.affiliation: Memorial Regional Hospital, Hollywood, Florida.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayes
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jokich
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Su-Ju
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Mainiero
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania; Society of Nuclear Medicine, Reston, Virginia.
authors.forename: David A
authors.initials: DA
authors.lastname: Mankoff
authors.affiliation: Radiology Inc., Mishawaka, Indiana.
authors.forename: Samir B
authors.initials: SB
authors.lastname: Patel
authors.affiliation: University of Miami, Miami, Florida.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Yepes
mesh_terms: D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008495:Medical Oncology / Q000592:standards; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States; D016387:Women's Health / Q000592:standards
keywords: Appropriateness Criteria; early-stage breast cancer; metastatic disease; recurrence