Too Many Pre-Op Imagining Studies?

Researchers from the Fox Chase Cancer Center (FCCC) have reported that a study they conducted has shown that more and more women are being asked by their physicians to have several different types of additional imaging studies done before they can have their surgery. Spot films, ultrasounds, and breast MRIs are common now, and all of these can assist surgeons in selecting the best surgical method to be used in the operating room.

The Fox Chase researchers say that most women nowadays who are about to have surgery for breast cancer must go for more than two additional imaging visits after they've been diagnosed. And the scientists report that if you add up all the imaging studies these women must have today--both before and after their diagnosis--it turns out that women are now required to undergo four times the number of imaging studies they used to get before the mid-1990s.

Fewer Imaging Studies in the Past

In 1992, only 4.3 percent of patients underwent multiple types of imaging; by 2005, that rate had risen to 27.1 percent. The Fox Chase faculty members said that not only do these extra studies delay a woman's surgery, but they also increase these patients' out-of-pocket expenses, since it is rare today for an insurance company to pay 100 percent of the cost of supplementary tests like these.

Where this Research Will Go Next

The Fox Chase researchers say that they will now be conducting additional research using these data to determine how these extra imaging tests specifically influenced the planning of these patients' surgical treatment. These findings will then be linked to whether the extra imaging studies actually made a difference in clinical outcomes.
The future research studies will be looking at such things as whether the extra imaging improved breast-conservation rates (lumpectomies with radiation vs. mastectomies) or lowered re-excision rates. Also scrutinized will be the number of days from diagnosis to surgery, as well as how the extra waiting times might have impacted the size and growth of tumors.

Evolving Technologies

New technologies like digital mammography and breast MRIs are giving surgeons today a lot more information about breast tumors, information that can have important things to say about how an operation should be performed. Thus, many of these additional imaging studies are done in an effort to find out as much as possible about the tumor before the surgeon must operate.

A digital image, for example, is 28-percent more accurate than one taken with the old analog film. But back in 2005, only 30 percent of imaging facilities had digital mammography. Even some breast-imaging facilities today don't offer digital--so obviously, fewer extra imaging studies were done back then.

The other thing driving up the numbers of imaging studies is the development of breast MRIs. Before an operation, MRIs can greatly help surgeons to (virtually) see through the dense breast tissues that often show up on mammograms, so the surgeons can better understand what is going on within the breast tissue. Surgeons are thus provided with more specific information about the size and location of a tumor, as well as whether more than 1 tumor is present.

Timing Is Important

The kicker, however, is that an MRI, in order to take its wonderfully accurate images of a pre-menopausal woman's breast, must be done at a specific time during the menstrual cycle. This fact can add even more delays in completing these newer imaging studies, but the newer technologies do allow surgeons to give patients a more definitive recommendation about what surgical options they have (i.e., lumpectomy or mastectomy vs. either option.)


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