title: Variation in Practice of the Diagnostic Workup of Asymptomatic Patients Diagnosed with Invasive Breast Cancer.
abstract: BACKGROUND
  Breast cancer is frequently diagnosed, yet variation remains in terms of practice patterns in presurgical workup. We sought to determine factors associated with this variation.
  
  
  METHODS
  An anonymous web-based survey was distributed to surgeons regarding their practices. Statistical analyses were conducted using SPSS.
  
  
  RESULTS
  A total of 253 surgeons responded to the survey. 17.0% were in academic practice, 37.5% were hospital employed, and 41.5% were in private practice. 53.3% claimed that >50% of their practice was breast related. Surgeons were asked how often they would use various tests in the workup of an otherwise healthy asymptomatic patients, presenting with a non-palpable mammographic abnormality and a core needle biopsy showing invasive breast cancer. 23.5% stated that they always would obtain a breast ultrasound, 17.2% stated that they never would. 12.8% stated that they never order a breast MRI; 4.1% always would. Workup of patients did not vary significantly based on number of years in practice nor practice setting. However, those whose practice was >50% breast were more likely to state that they would always order a breast ultrasound (32.5 vs. 12.9%, p < 0.001), and less likely to state that they would never order a breast MRI (3.4 vs. 25.8%, p < 0.001). However, the proportions of surgeons who would always order a breast MRI were similar in the two groups (3.4 and 3.2%, respectively).
  
  
  CONCLUSIONS
  These data highlight the lack of uniformity in the workup of asymptomatic patients presenting with non-palpable breast cancers, pointing to potential areas for improving value by minimizing variability.
authors.affiliation: Department of Surgery, Yale University , New Haven, CT , USA.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.affiliation: Department of Surgery, University of Texas MD Anderson Cancer Center , Houston, TX , USA.
authors.forename: Gildy V
authors.initials: GV
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, University of Texas MD Anderson Cancer Center , Houston, TX , USA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.affiliation: Department of Surgery, McPherson Hospital , McPherson, KS , USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Hughes
keywords: breast cancer; guideline adherence; tests; variation; workup