Breast cancer, a malignant tumor that begins in the cells of the breast, affects one in eight women during their lives.
An annual mammogram is recommended after treatment for breast cancer, However, nearly one-third of women diagnosed with breast cancer aren't
receiving this follow-up exam, revealed new findings presented at
the 2016 Annual Clinical Congress of the American College of Surgeons.
‘Over 30% of women do not get surveillance breast imaging after breast cancer treatment, revealed a new study.’
While previous studies on Medicare patients suggest that
surveillance imaging is underutilized, the use of mammography in a broad
range of women diagnosed with breast cancer is unknown, as is the role
of surveillance magnetic resonance imaging (MRI).
For this study, Caprice C. Greenberg of the
University of Wisconsin School of Medicine and Public Health, and
colleagues assessed the receipt of surveillance breast MRI and
mammography in 9,622 women who underwent a surgical procedure to treat
Stage II and III breast cancer from 2006 through 2007 with data
collected from the National Cancer Database (NCDB).
The NCDB is jointly
sponsored by the American College of Surgeons and the American Cancer
Society. Dr. Greenberg is professor of surgery and Morgridge
Distinguished Chair in Health Services Research, of the University of
Wisconsin School of Medicine and Public Health, Madison.
The researchers assessed imaging, cancer recurrence, new cancer,
and death from the time of treatment and for five years after diagnosis.
Next, they collected additional data on the reason for imaging
(diagnostic evaluation of a new sign or symptom or surveillance imaging
in the absence of signs and symptoms). 50% of the study
population was under age 60.
"Most of what we know about breast imaging comes from small
studies or from Medicare data, a population that is 65 years old and
older," said Dr. Greenberg, who is also
the Director of the Wisconsin Surgical Outcomes Research Program
(WiSOR). "This study is the first to look at a large,
multi-institutional population of patients across all age groups."
According to study results, annual receipt of surveillance breast
imaging declined 8% from the first year (66%) to the
fourth year (58%). Study findings also indicate that among women
who received surveillance imaging, only about 10% received
"The most striking finding is that over 30% of women don't
even get surveillance breast imaging in the first place," Dr. Greenberg
said. "For some reason, we are not plugging them into follow-up
surveillance from the outset. We also see that there are some
disparities in the use of mammograms after the treatment of breast
The study shows that factors associated with not receiving breast
imaging include younger age, black race, public or no insurance, worse
health, more advanced cancers, receipt of excision alone or mastectomy
(versus lumpectomy with radiation), and lack of systemic therapy.
"The critical story here is that if women start off their
follow-up care receiving guideline-recommended imaging, they're likely
to continue to receive that imaging over time. Women who don't receive
imaging in that first follow-up year are not likely to receive
recommended surveillance breast imaging longer-term," said study
co-author Jessica R. Schumacher, an associate scientist at WiSOR. "The bulk of the disparity seems to occur in that first year of follow
up, so it's really important to think about what we might be able to do
in that timeframe to make sure women get guideline-recommended breast
In looking at the use of both MRI and mammography, the
researchers found that receipt of mammography was not influenced by
where a woman received her care, but MRI was.
"This finding shows that the problem is probably at the patient
population level, as opposed to what we often see, which is that there
is great variation in utilization of care across hospitals," Dr.
Greenberg said. "MRI is a discretionary modality and not currently
recommended in guidelines for routine surveillance following breast
cancer treatment, but helpful and appropriate in certain patients.
Therefore, it's much more vulnerable to local practice patterns, whereas
mammogram is something we all know is effective and, in general, the
likelihood of getting it doesn't matter where you receive your care."
Understanding why cancer survivors aren't receiving surveillance
breast imaging and the consequences of this underutilization should be a
high priority, the researchers note.
"We need to recognize the fact that, right now we are putting out
more and more guidelines to help standardize care and to ensure
patients get high quality care, but the guidelines that are already out
there have been available for a long time. So I think it's important
for health care practitioners to realize that it's not enough to just
put information out there. Instead, we have to be more thoughtful about
how we implement what we recommend into the actual care process," Dr.