ROUTINE BONE SCANNING IN PATIENTS WITH T1 AND T2 BREAST-CANCER - A WASTE OF MONEY

Background: Bone scans are often performed as routine staging procedur es for patients with T1 and T2 breast cancers. Bone scanning in this p atient population is evaluated with respect to cost and impact on clin ical management. Methods: Three hundred sixteen women with clinical T1 or T2 breast cancer who had bone scans were treated at Fox Chase Canc er Center from January of 1991 to December of 1992. We reviewed clinic al and pathologic tumor stage, nodal status, laboratory studies, sympt oms, bone scans (frequency, results, and cost), and resultant studies. Results: Sixty-three women (20%) had bone scans that were interpreted as positive or suspicious for metastatic disease on initial presentat ion, resulting in 105 confirmatory studies, including 80 plain films, 10 computed tomography (CT) scans, 11 magnetic resonance imaging (MRI) scans, and four biopsies. Seven patients (2%) had skeletal metastases , six of whom had clinical stigmata of distant disease. A single patie nt (0.3%), with no signs or symptoms of distant disease, had bone meta stases. The initial bone scans cost $224,676; additional tests cost an other $53,122. The initial positive predictive value of bone scans in detecting metastatic disease was 11%. The ''baseline'' bone scans were followed by 130 ''follow-up'' scans over 2 years at a cost of $92,400 . Seven patients developed metastatic disease, confirmed by 31 additio nal studies. Again, only one patient was asymptomatic. The availabilit y of initial studies for comparison did not prevent thorough evaluatio n in women with worrisome follow-up bone scans. Conclusions: Bone scan s of 316 woman at initial presentation with T1 or T2 breast cancer ide ntified one incurable patient whose management was changed. The cost w as $277,798. Bone scans contribute little information to the managemen t of asymptomatic patients.