Abstract
Background. Is a perioperative metastatic screening program indicated in patients presenting with primary operable breast cancer and no signs of distant metastases?
Patients and methods. The impact of staging results (chest X-ray, bone scanning, liver ultrasound) for prognosis, treatment, quality of life and costs was retrospectively analyzed in 1076 patients with an operable breast cancer and no clinical signs of metastases.
Results. Staging examinations revealed 30 (2.8%) distant metastases, 130 (12.1%) suspect findings and excluded metastases in 916 (85.1%) patients. Further diagnostic procedures confirmed distant metastases in 7 (5.4%) and excluded them in 123 (94.6%) out of 130 patients with suspect findings. Distant metastases were detected more frequently with increasing pathological tumor size (pT ≤q 2.0 cm: 1.6%, pT 2.1–5.0 cm: 3.0%, respectively pT > 5.0 cm: 15.1%; p < 0.001) and increasing number of involved axillary lymph nodes (pN0: 1.9%, pN1–3+: 1.8%, pN4–9+: 4.0%, pN ≥ 10+: 18.7%; p < 0.001). Due to false positive findings 123 (11.4%) patients had to live for a significant period of time with the psychological distress of suspected metastatic disease. The abandonment of a perioperative screening in 1076 patients saves costs of at least Euro 259,367.68.
Conclusions. In breast cancer patients without clinical signs of tumor spread perioperative screening for metastases is not warranted because of low frequency of metastases, false positive findings, missing therapeutic consequences and high costs.
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Brenner H, Hakulinen T: Long-term cancer patient survival achieved by the end of the 20th century: most up-to-date estimates from the nationwide Finnish cancer registry. Br J Cancer 85: 367-371, 2001
Niu Y, Fu X, Lv A, Fan Y, Wang Y: Potential markers predicting distant metastasis in axillary node-negative breast carcinoma. Int J Cancer 98: 754-760, 2002
Barry MC, Thornton F, Murphy M, Younis F, Watson RG: The value of metastatic screening in early primary breast cancer. Ir J Med Sci 168: 248-250, 1999
Samant R, Ganguly P: Staging investigations in patients with breast cancer: the role of bone scans and liver imaging. Arch Surg 134: 551-553, 1999
Ravaioli A, Tassinari D, Pasini G, Polselli A, Papi M, Fattori PP, Pasquini E, Masi A, Alessandrini F, Canuti D, Panzini I, Drudi G: Staging of breast cancer: what standards should be used in research and clinical practice? Ann Oncol 9: 1173-1177, 1998
Myers RE, Johnston M, Pritchard K, Levine M, Oliver T: Baseline staging tests in primary breast cancer: a practice guideline. CMAJ 164: 1439-1444, 2001
Ravaioli A, Pasini G, Polselli A, Papi M, Tassinari D, Arcangeli V, Milandri C, Amadori D, Bravi M, Rossi D, Fattori PP, Pasquini E, Panzini I: Staging of breast cancer: new recommended standard procedure. Breast Cancer Res Treat 72: 53-60, 2002
Dillman RO, Chico S: Radiologic tests after a new diagnosis of breast cancer. Eff Clin Pract 3: 1-6, 2000
Sakorafas GH, Tsiotou AG, Pavlakis G: Follow-up after primary treatment for breast cancer. Acta Oncol 39: 935-940, 2000
Donnelly J, Mack P, Donaldson LA: Follow-up of breast cancer: time for a new approach? Int J Clin Pract 55: 431-433, 2001
Tassinari D, Sartori S, Ravaioli A: Staging of breast cancer. Is the evidence so evident? Ann Oncol 12: 1653, D, 2001
Will BP, Berthelot JM, Le Petit C, Tomiak EM, Verma S, Evans WK: Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 36: 724-735, 2000
Kaplan E, Meier P: Nonparametric estimation from incomplete observation. Am Stat Assoc 53: 457-481, 1987
Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50: 163-170, 1963
Norum J, Andreassen T: Screening for metastatic disease in newly diagnosed breast cancer patients. What is costeffective? Anticancer Res 20: 2193-2196, 2000
Ravaioli A, Tassinari D, Panzini I, Milandri C, Amadori D: Staging of breast cancer: it is time to break with tradition and initiate the evidence-based-medicine age. J Clin Oncol 19: 1234, 2001
Wingo PA, Ries LA, Giovino GA, Miller DS, Rosenberg HM, Shopland DR, Thun MJ, Edwards BK: Annual report to the nation on the status of cancer, 1973-1996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst 91: 675-690, 1999
Vacek PM, Geller BM, Weaver DL, Foster RSJ: Increased mammography use and its impact on earlier breast cancer detection in Vermont, 1975-1999. Cancer 94: 2160-2168, 2002
Klemi PJ, Joensuu H, Toikkanen S, Tuominen J, Rasanen O, Tyrkko J, Parvinen I: Aggressiveness of breast cancers found with and without screening. BMJ 304: 467-469, 1992
ESMO: ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol 12: 1047-1048, 2001
Sant M: Differences in stage and therapy for breast cancer across Europe. Int J Cancer 93: 894-901, 2001
Hoffken K: The European experience. J Clin Oncol 19: 112S-117S, 2001
Curigliano G, Ferretti G, Colleoni M, Marrocco E, Peruzzotti G, De Cicco C, Paganelli G, Goldhirsch A: Bone scan had no role in the staging of 765 consecutive operable T(1-2)N(0-1) breast cancer patients without skeletal symptoms. Ann Oncol 12: 724-725, 2001
Hadley D, Fowble B, Torosian MH: Evidence for selective use of bone scans in early stage breast cancer. Oncol Rep 5: 991-993, 1998
Chen EA, Carlson GA, Coughlin BF, Reed WPJ, Garb JL, Frank JL: Routine chest roentgenography is unnecessary in the work-up of stage I and II breast cancer. J Clin Oncol 18: 3503-3506, 2000
Cooke AL: Baseline staging tests for breast cancer. CMAJ 166: 419, 2002
Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ: Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21, 3357-3365, 2003
NIH: National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst Monogr 5-15, 2001
Nabholtz J, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Vogel C, Weaver C, Walley M: Phase III trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) with FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node poitive breast cancer patients: interim analysis of the BCIRG 001study. Proc ASCO 21: 36a, #141, 2002
Rojas MP, Telaro E, Russo A, Fossati R, Confalonieri C, Liberati A: Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev CD001768, 2000
GIVIO Investigators: Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA 271: 1587-1592, 1994
Rosselli DT, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V: Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA 271: 1593-1597, 1994
Palli D, Russo A, Saieva C, Ciatto S, Rosselli DT, Distante V, Pacini P: Intensive v.s. clinical follow-up after treatment of primary breast cancer: 10-year update of a randomized trial. National Research Council Project on Breast Cancer Followup. JAMA 281: 1586, 1999
Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark G, Edge SB, Hayes DF, Hughes LL, Hutter RV, Morrow M, Page DL, Recht A, Theriault RL, Thor A, Weaver DL, Wieand HS, Greene FL: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20: 3628-3636, 2002
Bruneton JN, Balu-Maestro C, Raffaelli C, Mourou MY, Cambon P, Granon C: Indications for hepatic ultrasonography in breast cancer staging and follow-up. Breast Cancer Res Treat 37: 115-121, 1996
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Gerber, B., Seitz, E., Müller, H. et al. Perioperative Screening for Metastatic Disease is not Indicated in Patients with Primary Breast Cancer and no Clinical Signs of Tumor Spread. Breast Cancer Res Treat 82, 29–37 (2003). https://doi.org/10.1023/B:BREA.0000003917.05413.ac
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DOI: https://doi.org/10.1023/B:BREA.0000003917.05413.ac