The therapeutic modifications induced by pretreatment evaluation were studied in a consecutive series of 852 asymptomatic women with newly diagnosed primary breast cancer attending our center between 1980 and 1984. Staging tests included chest X-rays in 851 patients, bone X-rays in 831, alkaline phosphatase in 826, hepatic enzymes in 818, liver echography in 750 and bone scintigraphy in 504. The intended local treatment was changed for a systemic one in 8 patients due to suspicious abnormalities. The follow-up confirmed evidence of metastases in 6 out of 8 patients (bone: 4; liver: 1; lung: 1). Mastectomy, initially avoided in these 6 patients, was subsequently performed in 2 of them owing to slow progression of distant metastases. On the basis of the current study, pretreatment staging in asymptomatic primary breast cancer cannot be recommended due to the low prevalence of detectable metastases.
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