European guidelines on breast cancer screening and diagnosis

Should conventional staging exams vs. no staging exams be used for patients with clinical stage I breast cancer without symptoms suggestive of metastases?

The GDG noted that women with clinical stage I breast cancer receiving neo-adjuvant chemotherapy may be considered for conventional staging exams using imaging.

• The GDG considered the definition of stage groups according to the American Joint Commission on Cancer TNM Anatomic Stage Groups (8th ed.) listed in the ECIBC glossary.
• The GDG notes that there is still uncertainty with the evidence of detection rate using conventional staging exams with imaging.
• The GDG notes that psychological support may be indicated to assist with follow-up of clinical stage I breast cancers in place of staging exams using imaging for reassurance of women who are very distressed about the potential for metastases.

• The GDG suggests monitoring and evaluation efforts to improve compliance with this suggestion to not conduct staging exams using imaging for clinical stage I breast cancers.
• The GDG suggests assessment by the QASDG for recommendations and implementation of monitoring and evaluation.

• The GDG suggests further research to provide higher quality evidence on the detection rate with staging exams using imaging in clinical stage I breast cancers.
• The GDG suggests further research on clinical stage I breast cancers that are diagnosed and ultimately metastasise to determine causes, and whether the use of staging exams will impact outcomes.
• The GDG suggests further research to assess the impact of staging exams using imaging for clinical stage I breast cancers with different higher risk histology groups.
• The GDG suggests further research to assess possible subgroups within clinical stage I breast cancers and varying need for staging exams using imaging.
• The GDG suggests research on non-ionizing and low-radiation dose alternatives for staging exams using imaging.