Are Physicians Choosing Wisely When Imaging for Distant Metastases in Women With Operable Breast Cancer?
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
PURPOSE: In 2012, the American Society of Clinical Oncology (ASCO) published its inaugural Top Five recommendations for "choosing wisely" in oncology. One recommendation was to avoid imaging for metastatic disease in asymptomatic patients with early-stage breast cancer. We assessed whether local practice is in keeping with provincial practice guidelines and whether publication of the ASCO recommendations had any significant impact on this. METHODS: A retrospective review of staging imaging for distant metastases was performed in patients with primary operable (early-stage) breast cancer seen at a large Canadian academic cancer center. RESULTS: A total of 200 patient medical records were reviewed: 100 patients from 2011 (pre-ASCO Top Five), and 100 after September 2012 (post-ASCO Top Five). Baseline patient and tumor characteristics were similar in both groups. Overall, 169 patients (84.5%) underwent at least one imaging test (mean, 3.6 tests per imaged patient); 154 patients (77.0%) underwent imaging that was not in keeping with the spirit of the local guideline recommendations. The frequency of imaging did not change after publication of the ASCO recommendations. Furthermore, imaging to clarify indeterminate initial imaging was required in 51 (30.2%) of 169 patients. None of the confirmatory imaging results ultimately revealed metastatic disease. CONCLUSION: Despite the presence of local imaging guidelines, patients with early-stage breast cancer still undergo imaging for distant metastases. There was no reduction in imaging after publication of the ASCO Top Five recommendations. Broader knowledge translation strategies beyond publication are needed if recommendations are to be implemented into routine clinical practice.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it