Breast cancer survivors who have residual breast tissue are recommended to undergo mammographic surveillance annually. ASCO, the American Cancer Society (ACS), and NCCN recommend annual mammograms beginning at 1 year after the mammogram that led to the cancer diagnosis, and at least 6 months after the completion of postlumpectomy radiation.1–3 It has been shown that mammographic detection of asymptomatic recurrences is associated with earlier disease stage and increased overall survival.4–7
In contrast to the consistent recommendation for mammography of residual breast tissue in this setting, ACS, ASCO, and NCCN state that there is insufficient evidence to recommend for or against MRI for routine breast cancer surveillance.1–3 According to guidelines, breast MRI should never be used instead of mammography, and only in addition to mammograms for those with a >20% lifetime breast cancer risk based on very strong family history, with a known cancer predisposition syndrome, or who had radiation therapy to the chest between ages 10 and 30 years. Evidence to support MRIs among breast cancer survivors is limited,8,9 but a recent case series study suggested that MRI may be more specific in breast cancer survivors than in women with only genetic risk or a strong family history.10
Real-world adherence to breast imaging guidelines among mixed-age women with breast cancer has been understudied in the United States. In women aged >65 years diagnosed with stage I–II breast cancer between 1992 and 1999, a SEER-Medicare analysis revealed that only 78% underwent mammography during months 7 to 18 after diagnosis, and only 57% had mammography yearly within 3 years.11 Patients who continued to see oncology specialists and who were younger, white (vs black), and living in certain regions were more likely to undergo mammography. Other studies have shown similar findings in older patients diagnosed more than a decade ago, generally with only 3 to 4 years of follow-up.12–17 A recent study using survey responses from 1,040 breast cancer survivors aged >65 years in the National Health Interview Survey found that 78.9% self-reported receipt of a mammogram in the prior 12 months, including only 86% of the 365 who had a life expectancy >10 years.18 We aimed to expand on this work by assessing rates and predictors of breast MRI and mammography in a modern cohort of mixed-age breast cancer survivors, and investigating how rates of imaging changed as time passed after diagnosis.
Dr. Mougalian has disclosed that she has stock or other ownership interest with Gilead Services Inc. and Roche Holdings Ltd., has a consulting or advisory role with Eisai Pharmaceuticals and Hylapharm LLC, and has received research funding with NCCN/Pfizer. Dr. Lemaine has disclosed that she has stock or other ownership interest with Exact Sciences, has received honoraria from ACEL RX, has a consulting or advisory role with ACESE RX and Lifecell, has received research funding from Allergan, and has had travel expenses associated with activities listed herein paid by Bonti, ACEL RX, and Lifecell. Dr. Vachon has disclosed that she has a leadership role with and has received research funding from Grail Inc. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
Dr. Ruddy and Ms. Sangaralingham were supported by an NCCN Young Investigator Award (PI: Ruddy).
KhatcheressianJLHurleyPBantugE. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol2013;31:961–965.
SaslowDBoetesCBurkeW. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin2007;57:75–89.
GradisharWJAndersonBOBalassanianR. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1.2016. Accessed December 1 2016. To view the most recent version of these guidelines visit NCCN.org.
LuWLJansenLPostWJ. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat2009;114:403–412.
PaszatLSutradharRGrunfeldE. Outcomes of surveillance mammography after treatment of primary breast cancer: a population-based case series. Breast Cancer Res Treat2009;114:169–178.
HoussamiNCiattoS. Mammographic surveillance in women with a personal history of breast cancer: how accurate? How effective?Breast2010;19:439–445.
HoussamiNCiattoSMartinelliF. Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol2009;20:1505–1510.
BrennanSLibermanLDershawDDMorrisE. Breast MRI screening of women with a personal history of breast cancer. AJR Am J Roentgenol2010;195:510–516.
WeinstockCCampassiCGoloubevaO. Breast magnetic resonance imaging (MRI) surveillance in breast cancer survivors. Springerplus2015;4:459.
KeatingNLLandrumMBGuadagnoliE. Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol2006;24:85–94.
Carcaise-EdinboroPBradleyCJDahmanB. Surveillance mammography for Medicaid/Medicare breast cancer patients. J Cancer Surviv2010;4:59–66.
DoubeniCAFieldTSUlcickas YoodM. Patterns and predictors of mammography utilization among breast cancer survivors. Cancer2006;106:2482–2488.
BrawarskyPNevilleBAFitzmauriceGM. Use of annual mammography among older women with ductal carcinoma in situ. J Gen Intern Med2012;27:500–505.
EtimAESchellhaseKGSparapaniRNattingerAB. Effect of model of care delivery on mammography use among elderly breast cancer survivors. Breast Cancer Res Treat2006;96:293–299.
FieldTSDoubeniCFoxMP. Under utilization of surveillance mammography among older breast cancer survivors. J Gen Intern Med2008;23:158–163.
FreedmanRAKeatingNLPaceLE. Use of surveillance mammography among older breast cancer survivors by life expectancy. J Clin Oncol2017;35:3123–3130.
OptumLabs. OptumLabs in Review: 2016. Available at: https://www.optumlabs.com/content/dam/optum/resources/OptumLabs-2016-Review.pdf. Accessed May 2 2016.
NattingerABLaudPWBajorunaiteR. An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res2004;39(6 Pt 1):1733–1749.
GoldHTDoHT. Evaluation of three algorithms to identify incident breast cancer in Medicare claims data. Health Serv Res2007;42:2056–2069.
QuanHSundararajanVHalfonP. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care2005;43:1130–1139.
PeppercornJHorickNHouckK. Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: a natural experiment. Cancer2017;123:2506–2515.
KhanNFCarpenterLWatsonERosePW. Cancer screening and preventative care among long-term cancer survivors in the United Kingdom. Br J Cancer2010;102:1085–1090.
OnegaTCookAKirlinB. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat2011;129:269–275.
WirtzHSBoudreauDMGralowJR. Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat2014;143:541–550.
GiulianiOManciniSPulitiD. Patterns and determinants of receipt of follow-up mammography and/or clinical examination in a cohort of Italian breast cancer survivors. Breast Cancer Res Treat2016;158:543–551.
RisendalBCSedjoRLGiulianoAR. Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers. J Cancer Surviv2016;10:96–102.
TurnbullLBrownSHarveyI. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet2010;375:563–571.
ChoNHanWBoo-KyungH. Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years of younger at diagnosis and treated with breast conservation therapy. JAMA Oncol2017;3:1495–1502.
NewmanLAGriffithKAJatoiI. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol2006;24:1342–1349.
PierceLFowbleBSolinLJ. Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer1992;69:2831–2841.
ConnorCSTouijerAKKrishnanLMayoMS. Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg2000;179:22–26.
FreedmanRAKeatingNLPartridgeAH. Surveillance mammography in older patients with breast cancer—can we ever stop?JAMA Oncol2017;3:402–409.