Variation in metastatic workup for patients with invasive breast cancer

Abstract Background Despite guidelines, surgeons vary in the metastatic workup they order for their breast cancer patients. Methods Surgeons were surveyed as to their practices in ordering staging studies for their breast cancer patients using a Web-based survey. Nonparametric analyses were performed to determine factors associated with guideline adherence. Results Two hundred fifty-three surgeons responded to the survey; 55.8% had practices with ≥50% breast patients; 7.3% of respondents stated they always did a metastatic workup before surgery, 8.6% never did; only 52.4% ordered a metastatic workup only in patients with clinical stage III disease. Surgeons who had ≥50% breast-related practices were more likely to follow these guidelines ( P = .031). Only 17% stated that a computed tomography chest/abdomen and bone scan was their “usual” metastatic workup. Conclusions Nearly 40% of surgeons perform metastatic workup when they are not indicated, and few adhere to National Comprehensive Cancer Network guidelines in terms of the tests ordered.