FRIDAY, Dec. 23 (HealthDay News) -- Women with breast cancer
undergo many more imaging tests between diagnosis and surgery than
they did in the early 1990s, a new study finds.
The tests -- breast ultrasounds, MRIs and mammograms -- help
doctors determine the best course of treatment, but add to the
hassles and expense of care, the study says.
"The burden to the patient is increasing substantially," said study leader Dr. Richard Bleicher, an associate professor of surgical oncology at Fox Chase Cancer Center in Philadelphia. For older patients, especially, coordination of care is needed, he said.
Bleicher, a breast surgeon, evaluated data on more than 67,000
women in the United States diagnosed with breast cancer from 1992
to 2005. His intent was to clock the time and inconvenience
involved in multiple imaging appointments.
In 1992, he found that 1 in 20, or under 5 percent of patients,
had imaging twice or more during the preoperative period of about
37 days. By 2005, 1 in 5 patients, or nearly 20 percent, had two or
more imaging sessions.
"Patients are having a lot more imaging done overall," he said. "I can't tell you whether the imaging was appropriate or not appropriate."
The percentage of patients who had more than one type of imaging
on a given day increased more than six-fold, from about 4 percent
in 1992 to just over 27 percent in 2005, the study found.
A subgroup of 20 patients had five or more mammogram visits
during the pre-op period, he found.
For the study, the researchers used Medicare claims linked to
the U.S. National Cancer Institute's Surveillance Epidemiology End
Results data for women with breast cancer. They zeroed in on about
67,750 women over age 65 who had invasive cancer that hadn't spread
and who were scheduled for surgery.
Bleicher presented the findings earlier this month at the San
Antonio Breast Cancer Symposium. He urged his colleagues to
consider ways of streamlining the testing, with an eye to improving
treatment without raising costs.
The increase in imaging tests does not surprise Dr. Carol Lee,
head of the communications committee for the American College of
Radiology Breast Imaging Commission.
"Practices have changed," she said. "Standards of care have changed." Since 1992, imaging technology has advanced greatly, she said, noting there are more, and better, options.
One limitation of the study, she said, is that the outcomes are
not addressed. "This is not telling the whole story," she said.
"What gets lost in the numbers is, what are the possible benefits
of this additional imaging?"
"Yes, we are doing more tests," she said. "But we are not doing tests for the sake of doing tests."
Some states have laws that address self-referral, said Shawn
Farley, spokesperson for the American College of Radiology. The
specifics of the laws vary.
Lee agreed with Bleicher that doctors should strive for better
coordination of imaging tests.
If your doctor orders imaging, Bleicher recommends asking why
it's needed. You might also ask if the doctor expects more imaging
will be needed and if so, whether it's possible to schedule tests
together, he said.
The study was supported by the U.S. Public Health Service, the
American Cancer Society, the Commonwealth of Pennsylvania and
Research presented at meetings should be considered preliminary
until published in a peer-reviewed medical journal.
For more on
breast cancer imaging, see the American College of
Radiology patient information page.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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