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Invited Critique
May 1999

Invited Critique: Staging Investigations in Patients With Breast Cancer

Arch Surg. 1999;134(5):554. doi:10.1001/archsurg.134.5.554

I applaud the effort of the authors of this article to determine the value of bone scans and liver scans in the search for metastatic disease in patients who are newly diagnosed as having stage I or stage II breast cancer. This study demonstrated metastasis in only 0.8% of early stage breast cancer in 250 patients. In the 5 patients found to have unexpected metastatic disease, the therapeutic benefits are probably minimal in terms of overall survival. In addition, there are considerable disadvantages in the false-positive outcomes encountered with routine bone and liver scans. The false-positive rate reported in this article is 25% to 35%. The additional patient encounters resulting from false-positive test results and the exaggerated patient anxiety are not to be capriciously discounted. The elimination of nonproductive testing is essential to quality of care. This applies not only to evaluation at the time of initial breast cancer diagnosis but also to testing associated with long-term follow-up of patients with breast cancer.