Is MUGA scan necessary in patients with low-risk breast cancer before doxorubicin-based adjuvant therapy?

Doxorubicin-based chemotherapy in the adjuvant treatment of breast cancer h as become standard. Use of doxorubicin is limited by cardiac dysfunction; h owever, the incidence is dramatically reduced by limiting the dose to less than 550 mg/m(2). Although the cumulative dose in breast cancer is typicall y 240 mg/m(2), multiple gated acquisition (MUGA) scans are still recommende d for determining cardiac functional status in these patients. To examine t he need for this practice, we reviewed 296 patients who underwent surgery f or breast cancer at Roswell Park Cancer Institute between July 1997 and Dec ember 1998. Fifty-nine of 95 (62%) patients receiving doxorubicin-based reg imens, and 3 of 39 (7%) receiving nondoxorubicin regimens had pretreatment MUGA scans. The MUGA scans showed normal results in 58 patients and low-nor mal in 4 (6.5%), with no wall motion abnormalities encountered. There were no cases where doxorubicin was not used because of an abnormal MUGA scan. T here were no cardiac complications in the 59 women who received doxorubicin -based chemotherapy. MUGA will screen out few, if any, women under consider ation for doxorubicin-based adjuvant therapy; the decision to avoid doxorub icin can be made based on age and preexisting comorbidity. Guidelines recom mending routine use of MUGA before the administration of doxorubicin for ad juvant therapy for breast cancer should be reconsidered.