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Current Breast Cancer Reports

Erschienen in:

10.03.2018 | Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)

Choosing Wisely: Optimizing Routine Workup for the Newly Diagnosed Breast Cancer Patient

verfasst von: Spencer W. Trooboff, Ravinder Kang, Julie Margenthaler, Sandra L. Wong

Erschienen in: Current Breast Cancer Reports | Ausgabe 2/2018

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Abstract

Purpose of Review

The American Board of Internal Medicine Foundation’s Choosing Wisely (CW) campaign has promoted a dialogue about avoiding unnecessary medical services since 2012. We review the evidence base, trends in utilization, and implications of CW recommendations relevant to the routine workup of newly diagnosed early stage breast cancer patients.

Recent Findings

There are several CW recommendations addressing routine workup of newly diagnosed breast cancer:

• Do not perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis

- These studies are obtained in 10–20% of patients, especially those with Stage IIB disease

• Do not routinely order breast MRI in new breast cancer patients with average risk

- Evidence of long-term benefit to preoperative MRI is lacking, but approximately 1 in 4 breast cancer patients receive one, often leading to additional interventions

• Do not routinely order specialized tumor gene testing in all new breast cancer patients

- Evolving guidelines are expanding eligible populations for genetic assay driven clinical decision-making, with mixed implications for adjuvant chemotherapy utilization

• Do not routinely use sentinel node biopsy in clinically node negative women ≥ 70 years of age with hormone receptor positive invasive breast cancer

- The vast majority of such patients—85–90%— undergo sentinel node biopsy despite questions about the benefit of axillary staging in an elderly population

Summary

CW recommendations offer a useful starting point for the discussion of optimal routine workup for breast cancer. Continued efforts are needed to define the marginal value of different tests and interventions and to develop mechanisms to incentivize and measure adoption of best practices.

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Titel: Choosing Wisely: Optimizing Routine Workup for the Newly Diagnosed Breast Cancer Patient
verfasst von: Spencer W. Trooboff
Ravinder Kang
Julie Margenthaler
Sandra L. Wong
Publikationsdatum: 10.03.2018
Verlag: Springer US
Erschienen in: Current Breast Cancer Reports / Ausgabe 2/2018
Print ISSN: 1943-4588
Elektronische ISSN: 1943-4596
DOI: https://doi.org/10.1007/s12609-018-0268-9

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

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Choosing Wisely: Optimizing Routine Workup for the Newly Diagnosed Breast Cancer Patient

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet Onkologie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Update Onkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

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Weitere Artikel der Ausgabe 2/2018

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Local-Regional Evaluation and Therapy: Maximizing Margin-Negative Breast Cancer Resection Rates on the First Try

Immunotherapy in Breast Cancer: the New Frontier

Breast Density and the Importance of Supplemental Screening

HER2 Activating Mutations in Estrogen Receptor Positive Breast Cancer

Neu im Fachgebiet Onkologie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Update Onkologie