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With the goal of improving quality and reducing costs in cancer care, ASCO's Choosing Wisely campaign was established in 2012. It offers oncology-focused recommendations to guide practitioners towards evidence-based approaches and discourage the use of practices with minimal value. One such recommendation advocates avoiding PET, CT, and radionuclide bone scans in the staging of early-stage breast cancer (clinical stage I and II) at low risk for metastasis, as repeated testing with these imaging modalities can result in increased exposure to radioactive substances and ionizing radiation, raising concerns about potential long-term health risks.

A utilizing data from the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare database provides compelling evidence for the efficacy of the ASCO Choosing Wisely initiative in fostering evidence-based practices and reducing excessive healthcare costs.

The study demonstrated a modest reduction in low-value imaging following the release of the Choosing Wisely guidelines in 2012. However, a more substantial improvement emerged after guidelines reinforcement in October 2013, with reductions of 12.80% in 2014 and 15.80% in 2015.

This decrease highlights the positive impact of clear and consistent communication in promoting guideline adoption and ultimately improving patient care. Considering the consistent downward trend in imaging overuse observed during the 2 years following guideline reinforcement, further improvement in guideline adherence can be anticipated as more data become available.

The study's generalizability is strengthened by its utilization of a large, representative database (SEER-Medicare). The robust evaluation of the guideline's impact is facilitated by the application of interrupted time series analysis, which accounts for other potentially contributing factors.

There are, however, several limitations that merit consideration. As noted, the study's timeframe (2010-2015) might not capture the full long-term effect of the guideline. Additionally, the reliance on the SEER-Medicare database, which is based on Medicare claims data, presents limitations. Some Medicare beneficiaries may have supplemental insurance plans that cover imaging studies without generating a Medicare claim for them. Furthermore, the data were limited to individuals over 65 years old who were eligible for Medicare, potentially overlooking younger patients who might receive more frequent imaging due to a higher incidence of more aggressive cancers.

Despite these limitations, the study's findings hold substantial value. By demonstrating the effectiveness of the "Choosing Wisely" initiative in reducing overuse of imaging procedures for early-stage breast cancer, the research offers strong support for continued efforts in guideline development and dissemination.

This approach has the potential to significantly improve healthcare practices by minimizing unnecessary interventions, optimizing resource utilization, and ultimately improving patient outcomes.

Arun Kumar, MD, is a Hematology/Oncology fellow PGY-5 at Medstar Georgetown University Hospital in Washington, DC.; Amrita Devi, MBBS, is an Educational Commission for Foreign Medical Graduates-certified physician and an applicant for internal medicine residency training in the U.S.

Read the study here and an interview about it here.