Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer: value added or just cost?

Raphael J. Louie, Jennifer E. Tonneson, Minda Gowarty, Philip P. Goodney, Richard J. Barth, Kari M. Rosenkranz

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Current National Comprehensive Cancer Network guidelines for breast cancer staging include pre-treatment complete blood count (CBC) and liver function tests (LFT) to screen for occult metastatic disease. To date, the relevance of these tests in detecting metastatic disease in asymptomatic women with early-stage breast cancer (Stage I/II) has not been demonstrated. Although chest x-rays are no longer recommended in the NCCN guidelines, many centers continue to include this imaging as part of their screening process. We aim to determine the clinical and financial impact of these labs and x-rays in the evaluation of early-stage breast cancer patients. A single institution IRB-approved retrospective chart review was conducted of patients with biopsy-proven invasive breast cancer treated from January 1, 2005–December 31, 2009. We collected patient demographics, clinical and pathologic staging, chest x-ray, CBC, and LFT results at the time of referral. Patients were stratified according to radiographic stage at the time of diagnosis. We obtained Medicare reimbursement fees for cost analysis. From 2005 to 2009, 1609 patients with biopsy-proven invasive breast cancer were treated at our institution. Of the 1082 patients with radiographic stage I/II disease, 27.3 % of patients had abnormal CBCs. No additional testing was performed to evaluate these abnormalities. In the early-stage population, 24.7 % of patients had elevated LFTs, resulting in 84 additional imaging studies. No metastatic disease was detected. The cost of CBC, LFTs and chest x-rays was $110.20 per patient, totaling $106,410.99. Additional tests prompted by abnormal results cost $58,143.30 over the five-year period. We found that pre-treatment CBCs, LFTs, and chest x-rays did not improve detection of occult metastatic disease but resulted in additional financial costs. Avoiding routine ordering of these tests would save the US healthcare system $25.7 million annually.

Original languageEnglish (US)
Pages (from-to)99-103
Number of pages5
JournalBreast Cancer Research and Treatment
Volume154
Issue number1
DOIs
StatePublished - Nov 1 2015

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Blood Cell Count
Liver Function Tests
Thorax
X-Rays
Breast Neoplasms
Costs and Cost Analysis
Guidelines
Biopsy
Asymptomatic Diseases
Fees and Charges
Neoplasm Staging
Research Ethics Committees
Medicare
Referral and Consultation
Demography
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Louie, Raphael J. ; Tonneson, Jennifer E. ; Gowarty, Minda ; Goodney, Philip P. ; Barth, Richard J. ; Rosenkranz, Kari M. / Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer : value added or just cost?. In: Breast Cancer Research and Treatment. 2015 ; Vol. 154, No. 1. pp. 99-103.
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title = "Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer: value added or just cost?",
abstract = "Current National Comprehensive Cancer Network guidelines for breast cancer staging include pre-treatment complete blood count (CBC) and liver function tests (LFT) to screen for occult metastatic disease. To date, the relevance of these tests in detecting metastatic disease in asymptomatic women with early-stage breast cancer (Stage I/II) has not been demonstrated. Although chest x-rays are no longer recommended in the NCCN guidelines, many centers continue to include this imaging as part of their screening process. We aim to determine the clinical and financial impact of these labs and x-rays in the evaluation of early-stage breast cancer patients. A single institution IRB-approved retrospective chart review was conducted of patients with biopsy-proven invasive breast cancer treated from January 1, 2005–December 31, 2009. We collected patient demographics, clinical and pathologic staging, chest x-ray, CBC, and LFT results at the time of referral. Patients were stratified according to radiographic stage at the time of diagnosis. We obtained Medicare reimbursement fees for cost analysis. From 2005 to 2009, 1609 patients with biopsy-proven invasive breast cancer were treated at our institution. Of the 1082 patients with radiographic stage I/II disease, 27.3 {\%} of patients had abnormal CBCs. No additional testing was performed to evaluate these abnormalities. In the early-stage population, 24.7 {\%} of patients had elevated LFTs, resulting in 84 additional imaging studies. No metastatic disease was detected. The cost of CBC, LFTs and chest x-rays was $110.20 per patient, totaling $106,410.99. Additional tests prompted by abnormal results cost $58,143.30 over the five-year period. We found that pre-treatment CBCs, LFTs, and chest x-rays did not improve detection of occult metastatic disease but resulted in additional financial costs. Avoiding routine ordering of these tests would save the US healthcare system $25.7 million annually.",
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Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer : value added or just cost? / Louie, Raphael J.; Tonneson, Jennifer E.; Gowarty, Minda; Goodney, Philip P.; Barth, Richard J.; Rosenkranz, Kari M.

In: Breast Cancer Research and Treatment, Vol. 154, No. 1, 01.11.2015, p. 99-103.

Research output: Contribution to journalArticle

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