Background: The American Society of Clinical Oncology (ASCO) recently published its "Top 5" list for fiscal responsibility in oncology. One of the recommendations was to minimize imaging tests looking for metastatic disease in patients (pts) with early stage breast cancer (BC). This recommendation is in close agreement with other published guidelines. The objective of this study was to see whether physician practice patterns have changed following the publication of the "ASCO Top 5" list. Methods: A retrospective review of pts with operable early-stage BC seen at a large Canadian cancer centre was performed. All perioperative (pre- & post-operative) imaging ordered to detect distant metastases (e.g. in the chest, abdomen and bones) was captured. Additional data on demographics, surgical procedure, pathology, prognostic/predictive factors and treatment was also collected. Results: 200 pt charts were reviewed: 100 pre- & 100 post- the "ASCO Top 5" publication. Baseline pt and tumor characteristics were similar in both groups. In the Pre-Top 5 group, 83% had at least 1 staging imaging test. The total number of perioperative tests in this group was 293, for an average of 3.53 tests/pt imaged. In the Post-Top 5 group, 84% had at least 1 staging imaging test. The total number of perioperative tests in this group was 320, for an average of 3.81 tests/pt imaged (p=ns). Further imaging to clarify indeterminate perioperative imaging results was required in 51/167 pts imaged (31%). Radiologically evident metastases were found in only 2/200 pts (both stage 3). None of the clarification imaging showed metastatic disease. Conclusions: This study again highlights the very low yield from imaging in early stage BC. Confirmatory imaging was frequent and did not yield additional metastatic disease. Local practice patterns do not appear to be affected by the recent ASCO publication. Further study is needed to determine how to successfully implement the ASCO recommendation, as excessive imaging is cost prohibitive and can lead to unwanted treatment delays and exacerbate pt anxiety.