Routine chest roentgenography is unnecessary in the work-up of stage I andII breast cancer

Purpose: Clinical practice guidelines of many professional societies call f or routine staging chest x-rays (SCXR) for all patients with invasive cance r. Given the estimated 157,000 patients annually for whom this recommendati on pertains, this screening examination represents ct considerable health c are expenditure. If it were shown that SCXR rarely changed the management o f low-risk subsets of this population, it might be possible to selectively omit this practice from the care of these patients with substantial resulta nt cost savings. Patients and Methods: All patients with clinical stage I and II breast canc er presenting to the Baystate Medical Center from 1989 through 1997 were id entified through the Tumor Registry. Their hospital records were reviewed f or clinical presentation and documentation of SCXR. Results: One thousand four hundred ninety-four patients were identified wit h clinical stage I and II disease. SCXR were available for review on 1,003 patients. Only one asymptomatic patient wets upstaged to stage IV based on a SCXR. Two patients with primary lung tumors were also identified. These d ata demonstrate an asymptomatic pulmonary metastasis detection rate of 0.09 9% (95% confidence interval, 0.0% to 0.6%). The total charges of SCXR for t his group approached $180,000. Conclusion: These data demonstrate the low diagnostic yield and high cost o f routine SCXR in the management of asymptomatic patients with clinical sta ge I and stage II breast cancer. Because other studies have shown that SCXR changes neither quality of life nor overall survival, SCXR should be limit ed to symptomatic patients in whom metastatic disease is suspected. (C) 200 0 by American Society of Clinical Oncology.