Abstract P1-10-01: Are physicians "choosing wisely" when imaging for distant metastases in women with early stage (1 or 2) breast cancer? A population study
Notice bibliographique
Résumé
Abstract Background: The probability of detecting radiologically evident distant metastases in asymptomatic patients with early stage (stage 1 and 2) breast cancer (BC) is low. Published guidelines, including the 2012 American Society of Clinical Oncology (ASCO) "Top-5" recommendation for "choosing wisely" in oncology, recommend against imaging in these patients. Imaging is also associated with significant false positive results and the need for additional confirmatory imaging and/or invasive procedures. Despite this evidence-base, imaging continues to be over-utilized. We decided to quantify the rates of staging imaging in women with early breast cancer in Canada’s largest province to determine whether provincial practice patterns are in keeping with the spirit of the guidelines and the 2012 ASCO "Top-5" recommendation. Methods: Provincial registry data available through the Institute for Clinical Evaluative Sciences were used to identify all patients with a first diagnosis of stage 1 and 2 breast cancer who underwent breast cancer surgery. For each patient, all imaging of the most common metastatic sites (i.e. skeleton, thorax and abdomen) was captured from the date of diagnosis up until 3 months after definitive breast cancer surgery. Patients who received neoadjuvant therapy or with a prior history of any invasive malignancy were excluded. Results: Between 2007 and 2012, 27,236 patients with stage 1 and 2 BC were identified. Overall data are shown in the table: StageNo. of patients% having at least one imaging test (total)Total no. of imaging tests (mean per patient imaged)% of patients imaged who required confirmatory imaging (total)No. of confirmatory imaging tests performed (% of total imaging)114,11383% (11,713)40,464 (3.5)55% (6,420)11,202 (28%)213,12394% (12,330)53,729 (4.4)65% (7,983)16,292 (30%) The most common initial (i.e. not confirmatory) imaging modalities of the skeleton, thorax and abdomen, for both groups were, bone scan (19%; 12,799/66,699), chest x-ray (28%; 18,789/66,699) and abdominal ultrasound (20%; 13,387/66,699) respectively. Use of advanced imaging (isotope bone scans, CT, MRI, PET) to look at potential sites of metastasis represented 38% (11,063/29,262) and 46% (17,180/37,437) of initial imaging tests in stage 1 and 2 BC patients respectively. Conclusion: Imaging for distant metastatic disease in patients with stage 1 and 2 BC is commonly performed in Ontario despite multiple guidelines recommending against this. Advanced imaging (isotope bone scans, CT, MRI, PET) is commonly used as the initial imaging modality of choice. Of particular concern is the fact that 60% (14,403/24,043) of BC patients with early stage disease who were imaged required some form of confirmatory imaging. These results show the importance of the recent ASCO "Top-5" recommendation against staging imaging in such patients. The reasons for this disconnect between evidence and practice are not fully understood, but knowledge translation strategies beyond publishing guidelines or recommendations are required if we are to elicit a meaningful and sustained change in physician practice. Citation Format: Demetrios Simos, Christina Catley, Carl vanWalraven, Ian D Graham, Dean Fergusson, Angel Arnaout, Susan Dent, Mark Clemons. Are physicians "choosing wisely" when imaging for distant metastases in women with early stage (1 or 2) breast cancer? A population study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-10-01.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».