The department of defense experience in perioperative testing for metastatic disease in patients with breast cancer

Although multiple tests are often performed prior to surgery for the primary treatment of breast cancer, the role of perioperative testing has yet to be clearly defined. The purpose of this study was to examine the use of perioperative testing in the Department of Defense (DOD) health care system. Records from all patients who received an operation for breast cancer between April 1, 1990 and March 1, 1992 in the DOD health care system were reviewed. The results of bone scans (BS), abdominal CT scans, brain scans (CT, MRI), chest radiographs (CXR), blood tests, and specified parameters from the history and physical examination were analyzed. Chi-square statistics were performed. 2,364 women underwent surgery for breast cancer during this period. The percentage of patients that received each test (A) and the percentage of the tests that were suggestive of metastatic disease (B) are as follows ([A%], [B%]): CXR (94%, 1.3%); BS (23%, 8%); abdominal CT (4%, 9%); and brain scans (1%, 11%). There were more abnormal BS in patients with an elevated alkaline phosphatase than in those with a test that was normal or never performed (20% vs. 4.8%, p < 0.001). Elevated liver function tests or central nervous system signs or symptoms were not associated with abnormal studies. In the past, patients with breast cancer underwent an extensive array of blood tests, CXR, and scans of bones, liver, and brain in the attempt to detect occult metastatic disease prior to surgery. In a large and diverse system such as the DOD, however, a perioperative metastatic work-up, which includes a BS, brain scan, and abdominal CT scan is not routinely performed, suggesting that clinicians selectively perform specific tests during this period. Despite this tendency, when tests are performed on breast cancer patients in the perioperative period, they are infrequently suggestive of metastatic disease.