- Email: [email protected]
Is skeletal scintigraphy indicated in all patients with breast cancer?
Clinical Oncology(1991) 3:64 © 1991The RoyalCollegeof Radiologists
Clinical Oncology
Editorial Is Skeletal Scintigraphy Indicated in All Patients with Breast Cancer? P. E. Preece Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
One of the fundamental tenets of clinical oncology is that optimal planning of cancer treatment requires a thorough search for metastases at the time the patient presents. In the two following articles in this issue of Clinical Oncology, two independent British papers report a yield of about 6% or 7% positive initial bone scans in patients diagnosed as having breast cancer. If this relatively low rate of bone metastases truly reflected the 'early' nature of the disease process, this finding would be encouraging and laudable. Glynne-Jones et al. point out that the extent of initially positive scans is determined by the presence of metastatic disease at presentation, that is it reflects prevalence. Unfortunately, in the two series, a further 10% of
the subjects with apparently no metastases at presentation had positive scans within 5 years. In both series, possession of a positive initial bone scan indicates a poor prognosis. Since the prescription of adjuvant systemic therapy is currently being advocated and adopted for an ever-widening range of stages of breast cancer, the early identification of possible occult bony metastases is unlikely to result in any difference in the management of these patients. Both reports demonstrate clearly that it is no longer justified clinically or economically to arrange skeletal scintigraphy on all patients newly diagnosed as having breast cancer. Cost-effective practice requires limitation of this investigation to use in patients with certain well-defined indications.
Clinical Oncology
Editorial Is Skeletal Scintigraphy Indicated in All Patients with Breast Cancer? P. E. Preece Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
One of the fundamental tenets of clinical oncology is that optimal planning of cancer treatment requires a thorough search for metastases at the time the patient presents. In the two following articles in this issue of Clinical Oncology, two independent British papers report a yield of about 6% or 7% positive initial bone scans in patients diagnosed as having breast cancer. If this relatively low rate of bone metastases truly reflected the 'early' nature of the disease process, this finding would be encouraging and laudable. Glynne-Jones et al. point out that the extent of initially positive scans is determined by the presence of metastatic disease at presentation, that is it reflects prevalence. Unfortunately, in the two series, a further 10% of
the subjects with apparently no metastases at presentation had positive scans within 5 years. In both series, possession of a positive initial bone scan indicates a poor prognosis. Since the prescription of adjuvant systemic therapy is currently being advocated and adopted for an ever-widening range of stages of breast cancer, the early identification of possible occult bony metastases is unlikely to result in any difference in the management of these patients. Both reports demonstrate clearly that it is no longer justified clinically or economically to arrange skeletal scintigraphy on all patients newly diagnosed as having breast cancer. Cost-effective practice requires limitation of this investigation to use in patients with certain well-defined indications.