Preliminary Result on The Use of Bone Scan and Plain X-rays in the Evaluation of Bone Metastasis From Breast Cancer in a Tertiary Institution: A Study of 30 Patients

Title: Preliminary result on the use of bone scan and plain x-rays in the evaluation of bone metastases from breast cancer in a tertiary institution: a study of 30 patients. Background: Bone scan is superior to plain x-rays in diagnosing early bone metastasis in management of cancer patients be made known and exploited, so as to manage such cases before irreversible damages are caused. Objective: To evaluate the role of bone scan and plain x-rays in the management of bone metastasis from breast cancer as seen in a tertiary referral center. Materials and Methods: Between January to December 2000, 30 consecutive patients with histologically confirmed breast cancer and bone pain presenting for the first time in the clinic or attending follow up clinic, were studied. All the patients were investigated with bone scan and x-rays of relevant bones at first presentation of pain, irrespective of duration of symptoms. Study was conducted at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad Pakistan. Relevant patients' data on details of disease since onset were accessed from records. Results: Six patients had painful bone metastases for 3 months; fourteen had pain for 4 6 months; two had pain for 7.9 months; three had pain for 10 12 months; and five had pain for more than 12 months prior to treatment with radiotherapy. Of the twenty patients presenting with pain for 6 months and below, all had radiological confirmation of bone metastasis on bone scan and only one had radiological confirmation of bone metastasis with plain x-rays at time of initial investigation. All the patients having bone pain for at least 9 months had confirmation of bone metastasis with plain x-rays at initial investigations. All the patients with evidence of bone metastasis on bone scan were confirmed with plain x-rays after at least 9 months of onset of bone pain. Conclusion: Although the number of patients was few, waiting for 9 months for radiological confirmation of bone metastasis will definitely have adverse effects on the quality of life of patients, performance status and chance of controlling the symptoms for a long time. Therefore, bone scan should be in the initial staging investigations of all patients. Facility for bone scan and nuclear imaging should be made widely available in tertiary institutions including those in resource poor countries.