title: Variation in metastatic workup for patients with invasive breast cancer.
abstract: BACKGROUND
  Despite guidelines, surgeons vary in the metastatic workup they order for their breast cancer patients.
  
  
  METHODS
  Surgeons were surveyed as to their practices in ordering staging studies for their breast cancer patients using a Web-based survey. Nonparametric analyses were performed to determine factors associated with guideline adherence.
  
  
  RESULTS
  Two hundred fifty-three surgeons responded to the survey; 55.8% had practices with ≥50% breast patients; 7.3% of respondents stated they always did a metastatic workup before surgery, 8.6% never did; only 52.4% ordered a metastatic workup only in patients with clinical stage III disease. Surgeons who had ≥50% breast-related practices were more likely to follow these guidelines (P = .031). Only 17% stated that a computed tomography chest/abdomen and bone scan was their "usual" metastatic workup.
  
  
  CONCLUSIONS
  Nearly 40% of surgeons perform metastatic workup when they are not indicated, and few adhere to National Comprehensive Cancer Network guidelines in terms of the tests ordered.
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, First Floor, Suite A, New Haven, CT, 06510, USA; Breast Center, Smilow Cancer Hospital at Yale-New Haven, 20 York Street, First Floor, Suite A, New Haven, CT, 06510, USA. Electronic address: anees.chagpar@yale.edu.
authors.forename: Anees
authors.initials: A
authors.lastname: Chagpar
authors.affiliation: The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gildy
authors.initials: G
authors.lastname: Babiera
authors.affiliation: Department of Surgery, Hospital de los Valles, Quito, Ecuador.
authors.forename: Jose
authors.initials: J
authors.lastname: Aguirre
authors.affiliation: Department of Surgery, 1813 Grand Avenue, Keokuk, IA, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Caropreso
authors.affiliation: Department of Surgery, McPherson Medical and Surgical Associates, McPherson, KS, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Breast cancer; Guidelines; Metastatic workup; Surgeon; Variation