ACR Appropriateness Criteria Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women.
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.
NYU Clinical Cancer Center, New York, New York. Electronic address: linda.moy@nyumc.org.
Linda
L
Moy
Emory University Hospital, Atlanta, Georgia.
Mary S
MS
Newell
University of Cincinnati, Cincinnati, Ohio.
Mary C
MC
Mahoney
Imagimed, LLC, Rockville, Maryland; American College of Surgeons, Chicago, Illinois.
Lisa
L
Bailey
Invision Sally Jobe, Englewood, Colorado.
Lora D
LD
Barke
Ohio State University, Columbus, Ohio.
Selin
S
Carkaci
Emory University Hospital, Atlanta, Georgia.
Carl
C
D'Orsi
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Sharad
S
Goyal
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Bruce G
BG
Haffty
University of Virginia Medical Center, Charlottesville, Virginia.
Jennifer A
JA
Harvey
Memorial Regional Hospital, Hollywood, Florida.
Mary K
MK
Hayes
Rush University Medical Center, Chicago, Illinois.
Peter M
PM
Jokich
University of Cincinnati, Cincinnati, Ohio.
Su-Ju
SJ
Lee
Rhode Island Hospital, Providence, Rhode Island.
Martha B
MB
Mainiero
University of Pennsylvania, Philadelphia, Pennsylvania; Society of Nuclear Medicine, Reston, Virginia.
David A
DA
Mankoff
Radiology Inc., Mishawaka, Indiana.
Samir B
SB
Patel
University of Miami, Miami, Florida.
Monica M
MM
Yepes
D058070:Asymptomatic Diseases; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D055088:Early Detection of Cancer / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008495:Medical Oncology / Q000592:standards; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D014481:United States
Appropriateness Criteria; early-stage breast cancer; metastatic disease; recurrence