DISCUSSION
tumor, colorectal, and, Tumor, breast cancer, breast, colorectal, and prostate cancer, cancer, Two‐thirds, prostate cancer, Cancer
TUMOR, TUMOR, BREAST CANCER, CANCER, ONCOLOGY, PROSTATE CANCER, CANCER
We assessed the appropriateness of cancer‐related testing not recommended in the SCPs of early‐stage breast, colorectal, and prostate cancer survivors enrolled in a trial of SCP delivery. We accounted for provider reasons for test ordering based on documentation in the medical record, although surveying providers would be required to understand their full rationale. We found that (1) testing consistent with overuse mainly consisted of tumor markers for breast cancer and (2) a substantial minority (approximately one‐third) of imaging studies ordered outside of SCP recommendations were consistent with overuse.Tumor markers accounted for the majority of testing consistent with overuse, occurred exclusively at the community site, and were all breast cancer‐related testing. While the 2000 National Comprehensive Cancer Network guidelines included serum tumor markers for breast cancer (CEA, CA 15–3, and CA 27.29), all societal guidelines since then have recommended against this testing.Two‐thirds of imaging studies ordered, but not recommended on the SCP, were determined to be appropriate after adjudication. These tests included PET or bone scans to further evaluate a new concerning symptom, radiographic abnormality, or elevated guideline‐recommended tumor marker (i.e., PSA, CEA), and CTs ordered for breast reconstruction planning. With breast MRIs, we observed that the majority had indications for testing based on the American College of Radiology recommendations, which go beyond other national guidelines (e.g., American Society of Clinical Oncology, National Comprehensive Cancer Network). These findings bring attention to the variation in national cancer guidelines that may lead to a lack of clarity for clinicians trying to order appropriate surveillance testing. Different societies should consider collaborating to define individuals who may benefit most from breast MRI surveillance, using risk‐stratification to determine who is high risk based on the literature.This study had several strengths and limitations. We examined the appropriateness of cancer‐related testing by accounting for provider documentation in the medical record for any given test. While we know of three other studies that have assessed overuse of surveillance testing in a similar population of cancer survivors,In conclusion, our study found patterns of surveillance testing reflective of overuse relative to national guideline recommendations among breast, colorectal, and prostate cancer patients. In particular, tumor markers consistent with overuse were commonly ordered in early‐stage breast cancer survivors at the community site, and PET scans were used for routine surveillance across cancer types and both sites. Future larger studies should evaluate whether overuse testing is more prevalent in certain subgroups. Furthermore, these results suggest modifiable targets for reducing surveillance test overuse, and further studies using qualitative and mixed‐methods approaches should explore individual provider practice patterns and drivers of these testing patterns.