Chest radiography in the management of breast cancer

This study was undertaken to assess the utility of chest radiography (CXR) in the management of patients with breast cancer and to devise a suitable imaging policy for such patients. A retrospective analysis was performed of the case notes and the CXRs of a series of 141 patients presenting to this hospital in 1980 with a diagnosis of early breast cancer. Data retrieved covered the entire clinical course to date and included the number of CXRs performed for a clinical reason and the number performed as "routine". Correlation of the result of every CXR requested to subsequent therapeutic decision-making throughout the complete clinical course of each patient was undertaken and the proportion of CXRs initiating a management change, or performed for a clinical reason, out of the total requested was assessed. A total of 1161 CXRs were performed on the 141 patients studied. Of these, only 174 (15%) were undertaken for a direct clinical reason and 987 (85%) were undertaken as part of "routine" follow-up procedures and had no impact on patient management. Four "routine" CXRs (< 0.4%) demonstrated previously undiagnosed pulmonary metastases, in patients with no other history of metastatic disease. Thus, routine chest radiography is not a cost-effective method of monitoring asymptomatic patients with breast cancer for metastasis. It is recommended that outside staging procedures for clinical trials, the CXR is used only to address a clinical problem relating specifically to the thorax. It is anticipated that the cessation of all other chest radiography in patients being followed up for breast cancer at this institution will have significant budgetary implications.