Introduction. Certain clinicopathological factors are associated with a higher likelihood of distant metastases in primary breast cancer. However, there remains inconsistency in which patients undergo formal staging for distant metastasis and the most appropriate investigation(s). Aims. To identify UK surgeon preferences and practice with regard to staging investigations for distant metastases. Methods. A survey was disseminated to members of the Association of Breast Surgery by e-mail regarding surgeon/breast unit demographics, use of staging investigations, and local policy on pre/postoperative staging investigations. Several patient scenarios were also presented. Results. 123 of 474 (25.9%) recipients completed the survey. Investigations routinely employed for patients diagnosed with early breast cancer included serological/haematological tests (72% respondents), axillary ultrasound (67%), liver ultrasound (2%), chest radiograph (36%), and computed tomography (CT) (1%). Three areas contributed to decisions to undertake staging by CT scan: tumour size, axillary nodal status, and plan for chemotherapy. There was widespread variation as to criteria for CT staging based on tumour size and nodal status, as well as the choice of staging investigation for the clinical scenarios presented. Conclusions. There remains variation in the use of staging investigations for distant disease in early breastcancer despite available guidelines. 1. Introduction Accurate disease staging is important in decision-making for patients with primary breast cancer, both in treatment planning (locoregional versus systemic therapy) and in establishing the likely prognosis. Determining the presence of metastasis both at presentation and after initial treatment is a key factor in optimal diagnosis and determining ongoing treatment [1, 2]. Despite guidelines it is unclear if there is consistency as to the most appropriate initial staging investigations, and therefore the type and timing of staging investigations vary greatly between units. The likelihood of metastatic disease at the time of breast cancer diagnosis is very low [1], so there is no clear evidence to support universal baseline intensive staging, and in fact several studies have suggested that staging in this manner is of limited value [1–7]. The yield of staging investigations is particularly low for patients with small tumours and negative axillary nodes. However, many patients continue to undergo extensive staging at the time of diagnosis [8–10]. Overstaging can lead to unnecessary resource use (which could be better
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