Purpose: to analyze the frequency of preoperative bilateral synchronic cancer and occult metastases in 454 operable breast cancer patients, at Instituto Nacional de Câncer (Brazil). Methods: the preoperative evaluation consisted of mammography, bone scan with X-ray if necessary, and chest X-ray. 260 (57.3 %) of 454 patients underwent liver echography. We calculated the cost X effectiveness ratio considering only the direct costs (monetary value) and the effectiveness was analyzed based on the number of metastases identifid by the screening tests. Results: we did not find any case of bilateral synchronic cancer, and the frequency of patients with metastasis was 2% (9/454). The diagnosis of bone metastasis was 1.5 % (7/454). The percentage of lung (2/454) and liver (1/260) metastasis was the same, 0.4 %. Most of the patients with metastases were in stage IIIb (44.5 %). The results of the screening tests showed the alteration of the initial clinical stage in 9 patients only (2%). The total cost of the screening tests for the diagnosis of systemic disease in 9 patients, was US$ 131,020.00. The cost of each diagnosed metastasise, for a total of 10 (two were found in one of the patients), was US$ 29,221.85 and the cost/effectiveness ratio was 22.3%. Conclusious: the results showed that screening for metastases in the preoperative clinical staging of breast cancer should be limited to patients symptomatic for systemic disease or in clinical stage III and that the cost/effectiveness ratio of the tests demonstrated a reduced benefit in the preoperative evaluation.
Breast cancer; Metastasis; Health care costs; Ultrasonography
