Healthcare question

Should conventional staging exams vs. no staging exams be used for patients with clinical stage 2 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 2a or 2b breast cancer.

Recommendation strength ­

  Conditional recommendation against the intervention

  Low certainty of the evidence

Subgroup considerations

  1. For clinical stage II breast cancers, the GDG notes that there is no evidence of an increased detection rate according to hormone receptor and HER2 status, although these results might influence the decision to conduct further imaging because of the possible impact on treatment strategies.
  2. The GDG also notes that age and presence of comorbidities of the patient may be a consideration in the decision of whether to conduct staging exams with imaging as this may change the choice of treatment.
  3. Subgroups based on histological and marker results may impact the need to conduct staging examinations using imaging.

Considerations for implementation and policy making

  1. The GDG notes that a positive on imaging staging exams may be managed differently in different settings and in different body sites; if the presence of a distant metastasis on staging exams results in initiation of treatment, the impact of false positives may be greater.
  2.  The GDG considered the definition of ‘clinical stage’ as pre-pathological clinical stage, in accordance with the definition listed in the ECIBC glossary.
  3. The GDG notes that there is still uncertainty with the evidence of detection rate using staging exams with imaging.
  4. Consultation with colleagues during the interdisciplinary cancer treatment team meetings may be helpful in limiting the need for staging exams.
  5. Education of healthcare providers to limit the use of staging exams using imaging for clinical stage 2a/2b breast cancer.

Research priorities

  1. The GDG notes that no research evidence was identified on how people value the main outcomes. The GDG suggests additional research on how people value the main outcomes of staging exams for detection of metastases.
  2. The GDG suggests further research on marker results and the implications for using staging exams using imaging.
  3. Further research on the psychological effects and values and preferences for women related to the consequences of staging and non-staging approaches.

Monitoring and evaluation

The GDG suggests monitoring for compliance that routine staging exams using imaging are not conducted due to the undesirable effects, including increased false positives with small desirable effects.

Supporting documents