Healthcare question

Should conventional staging exams vs. no staging exams be used for patients with clinical stage 1 breast cancer without symptoms suggestive of metastases?

Recommendation

The ECIBC's Guidelines Development Group (GDG) suggests against using staging exams with imaging in women with clinical stage 1 breast cancer.

Recommendation strength ­

  Conditional recommendation against the intervention

  Low certainty of the evidence

Subgroup considerations

The GDG noted that women with clinical stage 1 breast cancer receiving neo-adjuvant chemotherapy may be considered for conventional staging exams using imaging.

Considerations for implementation and policy making

  1. The GDG considered the definition of stage groups according to the American Joint Commission on Cancer TNM Anatomic Stage Groups (8th ed.).
  2. The GDG notes that there is still uncertainty with the evidence of detection rate using conventional staging exams with imaging.
  3. The GDG notes that psychological support may be indicated to assist with follow-up of clinical stage 1 breast cancers in place of staging exams using imaging for reassurance of women who are very distressed about the potential for metastases.

Research priorities

  1. The GDG suggests further research to provide higher quality evidence on the detection rate with staging exams using imaging in clinical stage I breast cancers.
  2. The GDG suggests further research on clinical stage 1 breast cancers that are diagnosed and ultimately metastasise to determine causes, and whether the use of staging exams will impact outcomes.
  3. The GDG suggests further research to assess the impact of staging exams using imaging for clinical stage 1 breast cancers with different higher risk histology groups.
  4. The GDG suggests further research to assess possible subgroups within clinical stage 1 breast cancers and varying need for staging exams using imaging.
  5. The GDG suggests research on non-ionizing and low-radiation dose alternatives for staging exams using imaging.

Monitoring and evaluation

  1. The GDG suggests monitoring and evaluation efforts to improve compliance with this suggestion to not conduct staging exams using imaging for clinical stage 1 breast cancers.
  2. The GDG suggests assessment by the QASDG for recommendations and implementation of monitoring and evaluation.

Supporting documents

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"Evidence to Decision": recommendation justification, considerations and assessment
English (1.5 MB - PDF - 16 pages)
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"Evidence profile": quality assessment of the evidence from literature review and summary of findings
English (736 kB - PDF - 3 pages)
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Bibliography
English (550 kB - PDF - 1 page)
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