Who Should Get Metastatic Work-Up in Operable Breast Cancer Patients

Patients presenting with potentially operable breast cancer should be evaluated for occult metastatic disease if they have clinical stage III disease, per American Society of Clinical Oncology (ASCO) guidelines.

Patients with stage II disease have a low rate of finding distant metastases, and, therefore, such a work-up is not indicated.

While young age and triple-negative phenotype are poor prognostic factors, they do not influence whether patients should have a metastatic work-up independent of clinical stage.

Brennan ME, Houssami N. Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer. Breast. 2012;21:112-123.

Kim H, Han W, Moon HG, et al. The value of preoperative staging chest computed tomography to detect asymptomatic lung and liver metastasis in patients with primary breast carcinoma. Breast Cancer Res Treat. 2011;126:637-641.

Myers RE, Johnston M, Pritchard K, et al. Baseline staging tests in primary breast cancer: A practice guideline. CMAJ. 2001;164:1439-1444.

Schnipper LE, Smith TJ, Raghavan D, et al. American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol. 2012;30:1715-1724.

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