Under Utilization of Surveillance Mammography among Older Breast Cancer Survivors

Meyers Primary Care Institute, Worcester, MA 01605, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2008; 23(2):158-63. DOI: 10.1007/s11606-007-0471-2
Source: PubMed


Annual surveillance mammography is recommended for follow-up of women with a history of breast cancer. We examined surveillance mammography among breast cancer survivors who were enrolled in integrated healthcare systems.
Women in this study were 65 or older when diagnosed with early stage invasive breast cancer (N = 1,762). We assessed mammography use during 4 years of follow-up, using generalized estimating equations to account for repeated measurements.
Eighty-two percent had mammograms during the first year after treatment; the percentage declined to 68.5% in the fourth year of follow-up. Controlling for age and comorbidity, women who were at higher risk of recurrence by being diagnosed at stage II or receiving breast-conserving surgery (BCS) without radiation therapy were less likely to have yearly mammograms (compared to stage I, odds ratio [OR] for stage IIA 0.72, confidence interval [CI] 0.59, 0.87, OR for stage IIB 0.75, CI 0.57, 1.0; compared to BCS with radiation, OR 0.58, CI 0.43, 0.77). Women with visits to a breast cancer surgeon or oncologist were more likely to receive mammograms (OR for breast cancer surgeon 6.0, CI 4.9, 7.4, OR for oncologist 7.4, CI 6.1, 9.0).
Breast cancer survivors who are at greater risk of recurrence are less likely to receive surveillance mammograms. Women without a visit to an oncologist or breast cancer surgeon during a year have particularly low rates of mammography. Improvements to surveillance care for breast cancer survivors may require active participation by primary care physicians and improvements in cancer survivorship programs by healthcare systems.

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Available from: Chyke Doubeni, Mar 21, 2014
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    • "woman-years [11]. Despite recommendations for annual mammography put forth by entities, such as the National Comprehensive Cancer Network, the American Cancer Society, and the American College of Radiology, breast surveillance has been shown to be low among women who are elderly, black, had late-stage disease, had mastectomy or breast conserving surgery (BCS) without radiation, did not see a physician, and had more comorbid illnesses [12] [13] [14] [15] [16]. Also, adherence to surveillance mammography diminishes over time, with one "
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    ABSTRACT: Background. Patterns of surveillance among breast cancer survivors are not well characterized and lack evidence-based practice guidelines, particularly for imaging modalities other than mammography. We characterized breast imaging and related biopsy longitudinally among breast cancer survivors in relation to women's characteristics. Methods. Using data from a state-wide (New Hampshire) breast cancer screening registry linked to Medicare claims, we examined use of mammography, ultrasound (US), magnetic resonance imaging (MRI), and biopsy among breast cancer survivors. We used generalized estimating equations (GEE) to model associations of breast surveillance with women's characteristics. Results. The proportion of women with mammography was high over the follow-up period (81.5% at 78 months), but use of US or MRI was much lower (8.0%—first follow-up window, 4.7% by 78 months). Biopsy use was consistent throughout surveillance periods (7.4%–9.4%). Surveillance was lower among older women and for those with a higher stage of diagnosis. Primary therapy was significantly associated with greater likelihood of breast surveillance. Conclusions. Breast cancer surveillance patterns for mammography, US, MRI, and related biopsy seem to be associated with age, stage, and treatment, but need a larger evidence-base for clinical recommendations.
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    • "Some studies have suggested that older women with a personal history of breast cancer are less likely to receive surveillance mammography, especially women who had gone without a visit to a physician in the past year [53-55]. In addition, most of the women in this study did not require follow-up for an abnormal finding. "
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    ABSTRACT: Breast cancer screening rates have increased over time in the United States. However actual screening rates appear to be lower among black women compared with white women. To assess determinants of breast cancer screening among women in Michigan USA, focusing on individual and neighborhood socio-economic status and healthcare access. Data from 1163 women ages 50-74 years who participated in the 2008 Michigan Special Cancer Behavioral Risk Factor Survey were analyzed. County-level SES and healthcare access were obtained from the Area Resource File. Multilevel logistic regression models were fit using SAS Proc Glimmix to account for clustering of individual observations by county. Separate models were fit for each of the two outcomes of interest; mammography screening and clinical breast examination. For each outcome, two sequential models were fit; a model including individual level covariates and a model including county level covariates. After adjusting for misclassification bias, overall cancer screening rates were lower than reported by survey respondents; black women had lower mammography screening rates but higher clinical breast examination rates than white women. However, after adjusting for other individual level variables, race was not a significant predictor of screening. Having health insurance or a usual healthcare provider were the most important predictors of cancer screening. Access to healthcare is important to ensuring appropriate cancer screening among women in Michigan.
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    • "Based on data from the Breast Cancer Treatment Effectiveness in Older Women (BOW) study, Field et al. have shown that, by the fourth year after treatment, only 60% of breast cancer survivors aged 65 and over visit an oncologist or breast surgeon [16]. Less than 70% of women receive a surveillance mammogram during their fourth year of followup after breast cancer treatment [16]. "
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    ABSTRACT: We present the longest reported case of breast cancer recurrence, 52 years after initial diagnosis, in a patient initially treated with Halsted mastectomy. Observation and palpation of the chest wall resulted in late presentation, and this patient went on to demonstrate metastatic disease. Current surveillance guidelines lack specific recommendations regarding monitoring of the ipsilateral chest wall. In addition, the growing utilization of breast reconstruction poses an additional challenge to surveillance strategies of the ipsilateral breast. However, the emergence of MRI may present a new opportunity to identify ipsilateral recurrence. The changing landscape of breast cancer therapy warrants guidance from groups of national import such as ASCO, in the surveillance of breast cancer patients.
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