A Victorian clinician-based survey on current practices for breast cancer staging in pregnancy

Abstract

Background/aims: Incidence of cancer during pregnancy is rising.1 There is limited evidence, and no national guidelines regarding when to perform staging andwhich imaging modalities are safe and accurate during pregnancy. This study assesses current Victorian clinician practices for staging of pregnant women with breast cancer. Method(s): A study specific survey was administered to medical oncologists, surgeons, radiation oncologists, radiologists and specialty trainees at breast multidisciplinary meetings across regional and metropolitan Victoria. The questionnaire assessed clinician level of work experience, perceived indications for staging, and preferred imaging modalities in breast cancer patients who are pregnant. Result(s): One hundred three questionnaires were completed with an overall response rate of 87%. Eighty-seven cancer specialists (35 surgeons, 33 medical oncologists, 12 radiologists, seven radiation oncologists) and 16 trainees completed the survey. 76(74%) of clinicians had worked in their field for >6 years and 65(63%) had treated at least one pregnant woman with breast cancer. Two per cent of clinicians would not stage during pregnancy. Sixty-one (59%) would stage in locally advanced or inflammatory, 56(54%) in clinical node involvement, 79(77%) if strongly suspicious of metastatic disease. Fifty per cent and 59% of clinicians would order chest X-ray and liver ultrasound, respectively. Less frequently selected tests included CT chest (11%), whole spine MRI (8%), whole body MRI (8%), whole body bone scan (5%), andCT abdomen and pelvis (1%).87%of clinicians would like local or national guidelines in this area. Conclusion(s): There is variability in clinical practice for staging pregnant women with breast cancer. The majority of clinicians surveyed believe guidelines arewarranted.We plan to develop consensus guidelines on the use of imaging for staging of pregnant women with breast cancer.