Breast cancer patients face increasing number of imaging visits before surgery
Breast cancer patients frequently undergo imaging like mammograms or ultrasounds between their first breast cancer-related doctor visit and surgery to remove the tumor. Evaluations of these scans help physicians understand a person's disease and determine the best course of action. In recent years, however, imaging has increased in dramatic and significant ways, say researchers from Fox Chase Cancer Center. More patients have repeat visits for imaging than they did 20 years ago, and single imaging appointments increasingly include multiple types of imaging.
The researchers, led by Richard Bleicher, M.D., surgical oncologist at Fox Chase, found that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Bleicher says additional visits present a burden to patients, many of whom are elderly, but the stress may be alleviated through better coordination and evaluation by physicians. Bleicher will present his group's findings on Friday, December 9 at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.
"The burden to the patient is increasing substantially," Bleicher says. "The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising."
The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.
The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.
With the increased use of imaging, Bleicher says that for physicians, "the question becomes, 'How are we affecting patients overall with what we're ordering nowadays?'"
Previous studies have examined patient burden in terms of cost, but Bleicher says he hasn't seen studies that focus on the patient burden in terms of the patient's time. "I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging," he says. "Physicians need to keep in mind that it's hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it's harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient."
Other studies have shown an increase in the cost of breast cancer care but the cost of imaging is rising even faster. "We know the costs are going up, but we don't know why," he says. "One reason might be the frequency and amount of imaging."
He points out that when more than one set of imaging is done on the same day, "There are perversities of the reimbursement system that may foster these separate visits, although I don't know if that's why we're seeing this phenomenon."
The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment. The median age of the study participants was 75.
Bleicher says the patient's burden may be reduced if patients ask their providers why imaging is being done, and work together to make the process smoother. "If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they're going to need additional types of imaging and if those can be scheduled together," he says.
The researchers are now diving deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, Bleicher says. "We want to see whether or not there is a more efficient method of imaging the patients so that we're improving outcomes without increasing costs."
Provided by Fox Chase Cancer Center
- Study challenges routine use of MRI scans to evaluate breast cancer Sep 07, 2008 | not rated yet | 0
- MRI may be unnecessary prior to treatment in most newly diagnosed breast cancer patients Aug 14, 2009 | not rated yet | 0
- Breast cancer staging should include breast MRI, study suggests May 03, 2010 | not rated yet | 0
- Study challenges routine use of MRI scans to evaluate breast cancer Jun 26, 2009 | not rated yet | 0
- SNM releases new fact sheet on breast cancer and molecular imaging Oct 03, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
what is the distance traveled
1 hour ago Hi. I have newly started to study mechanical physics. based on study, I conduct a simple experiment. But unfortunately i am unable apply the laws in...
Image of a Convex Lens Cut in Half Horizontally
4 hours ago Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
Ray tracing throught optical system of thick lenses
5 hours ago Can you advise me a free software that allow to draw rays passed throught system of thick lenses (preferable in 3D)?
Faraday's law on circular wire
5 hours ago In my examples on Faraday's law in my book, they use a drawing of a magnet approaching a circular wire. The changing magnetic flux then induces an...
Specific Exergy vs Specific Flow Exergy
7 hours ago I'm having some difficulty understanding exactly what the difference between the definitions of these values are. As I understand it, in terms of...
The Durability of Bone: Long Falls
15 hours ago I am doing a paper on the physics in Valve's Portal and got interested in the "Long Fall Boots" that prevent any damage no matter how far you fall. I...
- More from Physics Forums - Classical Physics
More news stories
Indian doctors said Wednesday they have successfully carried out a first round of reconstructive surgery on the skull of a baby suffering from a rare disorder that caused her head to nearly double in size.
Surgery 4 hours ago | not rated yet | 0
(AP)—Doctors in Poland say they have performed an urgent total face transplant on a 33-year-old man whose face was torn off in an accident which also crushed his jaws.
Surgery 5 hours ago | not rated yet | 0
Surgeons investigated sexual function in 62 patients, 50 years and older, who had received extensive spinal–pelvic instrumentation for spinal deformity at the University of Virginia Health Center. Based on their results, ...
Surgery May 21, 2013 | not rated yet | 0
Physicians at Monash University and The Alfred Hospital in Melbourne, Australia describe the logistic, medical, and societal challenges faced in treating spine trauma in morbidly obese patients. Based on a case series of ...
Surgery May 21, 2013 | not rated yet | 0
Arachnoid cysts are a common type of brain lesion that is usually harmless, but with a risk of rupture or bleeding. A new study identifies risk factors for rupture or bleeding in children with "incidentally" detected arachnoid ...
Surgery May 21, 2013 | not rated yet | 0
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
50 minutes ago | not rated yet | 0 |
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
49 minutes ago | 4 / 5 (1) | 0 |
Researchers have developed a new drug delivery system that allows inhalation of chemotherapeutic drugs to help treat lung cancer, and in laboratory and animal tests it appears to reduce the systemic damage ...
39 seconds ago | not rated yet | 0 |
Moving objects attract greater attention – a fact exploited by video screens in public spaces and animated advertising banners on the Internet. For most animal species, moving objects also play a major ...
4 minutes ago | not rated yet | 0 |
In the long run, encouraging a baby to finish the last ounce in their bottle might be doing more harm than good.
2 minutes ago | not rated yet | 0 |
The human gut is loaded with commensal bacteria – "good" microbes that, among other functions, help the body digest food. The gastrointestinal tract contains literally trillions of such cells, and yet the ...
46 minutes ago | not rated yet | 0 |