The American Society of Clinical Oncology's Choosing Wisely® list recommends against performing a computerized tomography (CT or CAT) scan of the chest, abdomen or pelvis for routine breast cancer surveillance for recurrence in asymptomatic patients who have been treated with curative intent, citing their unproven effectiveness in improving survival. CT or CAT scan may be indicated if there is concern for disease recurrence (e.g., development of symptoms or lab abnormalities), to follow-up a prior abnormal CT/CAT scan finding, or for reasons that are not related to breast cancer.
The results below represent the percentage of women with newly diagnosed breast cancer between 7/1/2014 to 12/31/2014 who received CT scans or CAT scans of the chest, abdomen or pelvis later than 6 months from their definitive breast surgery date. These results are consistently calculated based on strict inclusion and measurement criteria applied to each institution's billing data. The exceptions noted above (i.e., development of symptoms or lab abnormalities, follow-up of a prior abnormal CT/CAT scan finding, CT or CAT scans performed for reasons that are not related to breast cancer) are not reflected in these criteria since they cannot be determined through billing data. Although this approach may overestimate the number of scans being done purely for routine surveillance for recurrent breast cancer, the chance that results are biased is minimized since patients of different health systems are unlikely to differ systematically in the likelihood of these exceptions.
Note: Results presented here are part of a federal grant from the National Cancer Institute (NCI) awarded to investigators at the Medical College of Wisconsin. The organizations participating in this project agreed to do so on a voluntary basis, and represent a majority of the WCHQ membership eligible for the study.