• Breast Cancer Disease Site Group. Baseline staging tests in primary breast cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Apr 30 [online update]. 14 p. (Practice guideline report; no. 1-14). [33 references]

• Routine bone scanning, liver ultrasonography, and chest radiography are not indicated before surgery.
• In women with intraductal and pathological stage I tumours, routine bone scanning, liver ultrasonography, and chest radiography are not indicated as part of baseline staging.
• In women who have pathological stage II tumours, a postoperative bone scan is recommended as part of baseline staging. Routine liver ultrasonography and chest radiography are not indicated in this group but could be considered for patients with four or more positive lymph nodes.
• In women with pathological stage III tumours, bone scanning, liver ultrasonography, and chest radiography are recommended postoperatively as part of baseline staging.
• In women for whom treatment options are restricted to tamoxifen or hormone therapy, or for whom no further treatment is indicated because of age or other factors, routine bone scanning, liver ultrasonography, and chest radiography are not indicated as part of baseline staging.

None provided

The recommendations are supported by 22 reports of 21 case series evaluating one or more of the staging tests in question: 20 studies evaluated bone scan, 4 liver ultrasound, and 2 chest radiography. The strength of the available evidence lies not in study design, which in some cases is quite weak, but principally in the number of patients that have been studied (5,407 for bone scans, 1,625 with liver ultrasounds and 3,884 with chest x-rays) and the corresponding narrow confidence intervals for the estimates of detection rate.

• Breast Cancer Disease Site Group. Baseline staging tests in primary breast cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Apr 30 [online update]. 14 p. (Practice guideline report; no. 1-14). [33 references]

Not applicable: The guideline was not adapted from another source.

2000 Feb 8 (updated online 2003 Apr 30)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario, Ontario Ministry of Health and Long-Term Care

Breast Cancer Disease Site Group

Members of the Breast Cancer Disease Site Group disclosed potential conflict of interest information.

None available

This summary was completed by ECRI on June 5, 2002. The information was verified by the guideline developer as of July 8, 2002. This summary was updated by ECRI on April 19, 2004. The information was verified by the guideline developer on April 29, 2004.