More than 40% of patients are unnecessarily imaged during treatment for low-risk prostate or breast cancer in some regions of the country, according to a report published March 12 online ahead of print in JAMA Oncology.
Lead author Danil V. Makarov, MD, and colleagues examined data on 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer, across 84 hospital referral regions (HRRs). Imaging tests, such as CT and bone scans for prostate cancer, as well as CT, MRI, and positron emission tomography scans for breast cancer, were overused at a rate of approximately 44.4% for men and nearly 42% for women.
Inappropriate use of imaging was strongly associated with the HRR in which patients were treated. For instance, HRRs in the Northeast reported using imaging tests for low-risk patients at greater rates, whereas others in the Northwest and Utah reported more appropriate use of imaging.
The authors noted that their study was performed on medical records from 2004 through 2007, before the American Society of Clinical Oncology worked with the American Board of Internal Medicine in a national effort to encourage appropriate use of health care resources. Choosing Wisely identified five health care practices unlikely to benefit low-risk patients, two of which were about imaging patients with prostate or breast cancer (choosingwisely.org/doctor-patient-lists/american-society-of-clinical-oncology).
“Our results reinforce the wisdom of policy planners to highlight reduction of inappropriate cancer imaging among their priorities,” Dr. Makarov said. “If we are to achieve better value-based care, we must focus on issues such as regional culture and infrastructure.”