Abstract

Preoperative screening for metastases (M) in patients with operable breast cancer (Ca) is a controversial question. The objective of the present study was to evaluate the frequency of hidden M, synchronic bilateral cancer and the monetary cost of this screening in situations in which surgery represents the initial treatment option for these patients.

On this basis, we conducted a retrospective study (60 months) of 454 patients with operable breast cancer registered at the National Cancer Institute, Brazil, in which we analyzed clinical staging. The patients were submitted to physical examination, mammography, bone scintgraphy complemented with radiography (Rx) in cases of hyperfixation of the radiotracer, chest Rx and hepatic ultrasonography (USG), this last exam being performed only on 260 (57,3%) patients. We did not identify in the medical records any clinical or operational reasons that would have justified not performing hepatic USG in all patients.

Screening for subclinical synchronous bilateral cancer in the contralateral breast was negative in all patients (0/454). The frequency of hidden metastasis was 2% (9/454). Bone metastasis were detected in 1,5% of patients (7/454), pulmonary M in 2/454 and hepatic M in 1/260, all with the same percentage of 0,4%.

The cost of the preoperative screening for hidden metastasis and synchronous bilateral cancer in the 454 patients was US$ 131,020.00. Considering that the number of metastasis identified was equal to 10, in 9 patients (one patient had synchronous liver and bone metastasis), each diagnosed metastasis cost US$ 13,102.00 (US$ 131,020/10).

We conclude that the cost of preoperative screening for metastasis in patients with operable breast cancer is high, with low effectiveness in identifying hidden metastasis in only a reduced number (9) of asymptomatic patients.

Key words: Breast cancer, screening, preoperative.